“CONCEPT OF ORAL HYGEINE IN AYURVEDA

WITH SPECIAL REFERENCE TO ARJUNA”

PROJECT SUBMITTED TO THE KERALA UNIVERSITY

OF HEALTH SCIENCES IN PARTIAL FULFILMENT OF THE
REQUIREMENTS FOR THE AWARD OF

POST GRADUATE DIPLOMA

IN
SWASTHAVRITTA AND YOGA
D.P.H(Ay)
By

JITHIN G C

Under the supervision of

Dr. Jyothi R. MD(Ay)

Professor
Dept. of Swasthavritta
Govt.AyurvedaCollege
Thiruvananthapuram

DEPARTMENT OF SWASTHAVRITTA
GOVERNMENT AYURVEDA COLLEGE
THIRUVANANTHAPURAM KERALA
202
 DEPARTMENT OF SWASTHAVRITTA
GOVERNMENT AYURVEDA COLLEGE
THIRUVANANTHAPURAM, KERALA

Certificate
This is to certify that this dissertation made by JITHIN GC on " CONCEPT OF

ORAL HYGEINE IN AYURVEDA WITH SPECIAL REFERENCE TO ARJUNA” under

my supervision and guidance. The findings are valuable and have contributed substantially

to the present knowledge on the subject. We strongly recommend this dissertation to be

forwarded to the adjudicators for acceptance as a partial fulfilment for awarding the degree

of POST GRADUATE DIPLOMA (AYURVEDA) in Swasthavritta &Yoga from the Kerala

University of Health Sciences.

Dr. Jyothi R. MD (Ay)

Professor
Department of Swasthavritta
Government Ayurveda college
Thiruvananthapuram
 DEPARTMENT OF SWASTHAVRITTA
GOVERNMENT AYURVEDA COLLEGE
THIRUVANANTHAPURAM, KERALA

Forwarding Certificate

This is to certify and forward the dissertation on “CONCEPT OF ORAL

HYGEINE IN AYURVEDA WITH SPECIAL REFERENCE TO ARJUNA” which is a
Bonafide project work done by JITHIN GC under the guidance of Dr. Jyoti R. MD(Ay)
Professor department of swasthavritta government ayurveda college Tripunithura to the
adjudicators for acceptance.

Dr Jyothi R. MD(Ay) Dr JAI. G. MD (Ay)

Professor Principal
Dept. of Swasthavritta Govt.Ayurveda College
Govt. Ayurveda College Thiruvananthapuram
Thiruvananthapuram
 DECLARATION

I, JITHIN GC hereby declare that this dissertation work entitled “CONCEPT OF

ORAL HYGEINE IN AYURVEDA WITH SPECIAL REFERENCE TO ARJUNA” is a
Bonafide record of the research work done by me under the guidance of Dr Jyothi R.
MD(Ay), Professor Department of Swasthavritta, Government Ayurveda College,
Thiruvananthapuram and that no part of this work has been presented earlier for any
Degree/Diploma or similar title of any other University.

Thiruvananthapuram JITHIN GC

Date:
ACKNOWLEDGEMENT

I with utmost politeness and thankfulness submit my relentless praises to the Almighty
for having bestowed me with strength, ability and patience to complete this project work.

I sincerely express my intense gratitude and indebtedness to my respected Guide Dr.

Jyothi R MD(Ay) Professor, Department of Swasthavritta, Govt. Ayurveda College,
Thiruvananthapuram for the meticulous guidance, timely advice and helping hand extended
throughout my study. Her valuable suggestions, constant inspiration, excellent supervision,
creative affirmation and encouragement helped me to carry out this project work.

I express my profound sense of gratitude towards Dr Sheela S MD(Ay), Professor and

HOD, Department of Swasthavritta, Government Ayurveda College, Thiruvananthapuram
for providing necessary facilities and moral support throughout the study.

I extend my sincere and heartfelt gratitude to Dr Jai. G MD (Ay), Principal, Govt.

Ayurveda College, Thiruvananthapuram for providing me facilities to carry out this
project work.

I extend my sincere gratitude to Dr. Sajitha Bhadran MD(Ay) PhD Associate professor
department of Swasthavritta, Dr Smitha Mary Shine MD(Ay) Assistant Professor, Dept.of
Swasthavritta, DR. Sudha S MD(Ay) Assistant Professor, Dept. of Swasthavritta, Dr Anoopa
Sivapal MD(Ay) Assistant Professor Govt. Ayurveda College, Thiruvananthapuram for their
kind support and valuable advice throughout the study period. I am extremely thankful to
Dr V K Sunitha MD(Ay) Professor and HOD, Dept. of Swasthavritta, Govt. Ayurveda
College Kannur, Dr. Jayan D professor &HOD Dept. Of Swasthavritta Govt. Ayurveda
college Tripunithura and Dr Sreeraj. S. K MD(Ay) Associate Professor, School of
Fundamental Research in Ayurveda, Tripunithura for their valuable suggestions and
support to complete the project.

I extend my deepest sense of gratitude to my beloved batchmates Dr Angitha Anand,

Dr Renjitha.P.R, Dr Alameen.A, Dr Anjana.R, Dr Gayathri.S, Dr Lekshmi. M.S, Dr
Sandeep Krishnan, Dr Sayali Sanjay Sathe, Dr Shibina.E.S, Dr Sruthi.M for their constant
inspiration and support during my project study.

Heartful thanks to my seniors Dr Chinnu.T.R, Dr Rahul Raj, Dr Shefeena.P, Dr

Vaisakh.R, Dr Veena Vijayan, Dr Vrinda.V, Dr Akshayakumar.M, Dr Cini.K, Dr Indu.A,
Dr. Linda Stanley Dr Pretty Susan Job, Dr Swathi Suresh, Dr Varalekshmi.V, Dr Veena
Ramesh, Dr Anchu.T.M, Dr Meere Sukumaran and Dr Pooja.S. Nair for their valuable
advice throughout the study period.

I take this opportunity to thank my juniors Dr Ariya.N.S, Dr Divya.V.G, Dr Jain

John, Dr Muhammed.V.K, Dr Nandini.M, Dr Nilesh Sanas, Dr Shehanas Shukkoor, Dr
Varsha Chandran, Dr Aparna.T.R, Dr Nourin Hassan and Dr Shilpa.S.V for their support
during the study.

I take this opportunity to express my deep sense of gratitude to all nonteaching staff
in the department, college and library for their support.

I thank Mr. M. Radhakrishnan, Top Printers & Graphics, Swamy’s Photostat,

Dharmalayam road for the neat publication of this dissertation work.

With great indebtedness I express my gratitude to my beloved parents Sri. Gladston

Joel and smt. Cicily KV for their blessings and constant inspiration throughout the study.

My special feeling of love towards my wife Mrs. Anna Sophia Nath for her support
and cooperation to fulfil my study.

Once again, I express my thanks to all persons, who directly or indirectly helped me
in my work. Last but not the least I thank all the listed and unlisted well-wishers.

JITHIN GC
 CONTENTS
page no.

Introduction……………………………………………………………….2

Review of literature………………………………………………………...3

Modern view

 Anatomy of oral cavity……………………………………………..4

 Oral hygiene practises………………………………………………22

 Oral diseases/health effects of poor oral hygiene…………………...35

 Oral hygiene health assessment tools……………………………….46

 Food for oral health…………………………………………………50

Ayurvedic view

 Mukha sareeram……………………………………………………..51

 Oral hygiene practises in ayurveda………………………………….60

 Ill effects of poor mukha swasthyam………………………………..90

Drug review

 Arjuna………………………………………………………………..97

Conclusion……………………………………………………………………106

References…………………………………………………………………….107
 Concept of oral hygiene in Ayurveda with special reference to arjuna

INTRODUCTION

Ayurveda's Swasthavritta branch focuses on healthy lifestyle practices and disease

prevention. This branch aids in achieving the notion of health, which is not just the absence of
disease or infirmity but rather a condition of whole physical, mental, and social wellbeing.
Ayurveda's preventative practices include dinacharya, rtucharya, achararasayana, sadvritta, and
aharavidhi, among others. The daily routine is known as dinacharva, the seasonal regimen is
known as ritucharya, and the beneficial habits are known as sadvrittas. These help us to realize
how much our acharyas focused on maintaining the health. All of these practices prevent
infections from spreading among people.
The dentistry is well represented in Ayurveda and has also listed a number of practices for
preserving oral hygiene, including dantadhavana, gandusha, kabala, and jihwa nirlekhana. we
can refer to these from Astanga Hridaya Astanga sangraha, Charaka Samhita, Susrutha
Samhitha, Bhavaprakasa, and Bhaishajvaratnavali. Under the categories of dinacharya and
mukharoga.

Dental public health is the science and art of preventing, controlling dental diseases and
promoting dental health through organized community efforts. It is that form of dental practice
which serves the community as a patient rather than the Individual. It is concerned with the
dental health education of the public, with applied dental research and with the administration
of group dental care programs as well as the prevention and control of dental diseases on a
community basis.
Oral health is defined by WHO as "the retention throughout life of a functional,
aesthetic and natural definition of not less than 20 teeth and not requiring a prosthesis". All of
dentistry includes those practices by individuals and communities that effect oral health status.
For making the people understand the importance of oral hygiene the year 1994 had declared
the slogan "oral health for a healthy life". March 20- Oral Health Day, February 9-The National
Toothache Day, first Friday in October- World Smile Day. March 6- Dentist Day. May- National
Gum Disease Awareness Month etc. are celebrated to promote awareness of the issues around
oral health and the importance of oral hygiene to looking after everyone old and young, to
make understand the benefits of a healthy mouth.
BACKGROUND OF THE STUDY

In order to prevent dental issues, such as the most frequent ones ie. dental cavities,
gingivitis, periodontal (gum) disorders, and bad breath maintaining good oral hygiene is
paramount important. It is the practice of keeping the mouth and teeth clean. Dental illnesses
have a serious impact on global and Indian public health. According to the WHO, dental health
is a crucial component of overall health. Dental caries and periodontal disease damage one's
health and wellbeing, reduce economic output, and have other negative effects on both an
individual and a communal level. A rising collection of scientific data over the past ten years
seems to point to a major connection between systemic diseases including coronary heart

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disease, respiratory infections, premature births, low birth weight newborns, etc. and
periodontal infections.

The WHO Global Oral Health Status Report (2022) estimated that oral diseases affect
close to 3.5 billion people worldwide, with 3 out of 4 people affected living in middle-income
countries. Globally, an estimated 2 billion people suffer from caries of permanent teeth and 514
million children suffer from caries of primary teeth. In 2022, the World Health Assembly
adopted the global strategy on oral health with a vision of universal health coverage for oral
health for all individuals and communities by 2030. A detailed action plan is under development
to help countries translate the global strategy into practice. This includes a monitoring
framework for tracking progress, with measurable targets to be achieved by 2030.
Alternative oral disease preventive and treatment methods that are secure, efficient,
and affordable are increasingly needed on a global scale. This is brought on by a growth in
illness prevalence, increased pathogenic bacterial resistance to chemotherapeutics and
antibiotics already in use, opportunistic infections in immunocompromised patients, and cost
considerations in poor nations. The majority of oral disorders are caused by bacterial infections,
and it is well known that medicinal plants have strong antibacterial effects on microorganisms.
The impact of novel herbal formulations and some old classical formulations on various
physiological indicators has not yet been fully investigated, despite much effort being put into
their development.

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REVIEW OF LITERATURE
1. MODERN VIEW
2. AYURVEDIC VIEW
3. DRUG REVIEW

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MODERN VIEW

ANATOMY OF ORAL CAVITY/MOUTH

The oral cavity, better known as the mouth, is the start of the alimentary canal. It has three
major functions:

 Digestion - receives food, preparing it for digestion in the stomach and small intestine
 Communication - modifies the sound produced in the larynx to create a range of
sounds.
 Breathing acts as an air inlet in addition to the nasal cavity

Divisions of the Oral Cavity

The oral cavity spans between the oral fissure (anteriorly the opening between the lips), and
the oropharyngeal isthmus (posteriorly - the opening of the oropharynx).
It is divided into two parts by the upper and lower dental arches (formed by the teeth and their
bony scaffolding). The two divisions of the oral cavity are the vestibule and the mouth cavity
proper2.

Vestibule
The vestibule of the mouth is a narrow space bounded externally by the lips and cheeks, and
internally, by the teeth and gums.
It communicates:
a. With the exterior through the oral fissure.
b. With the mouth open it communicates freely with the oral cavity proper. Even when the teeth
are occluded a small communication remains behind the third molar tooth.
The parotid duct opens on the inner surface of the cheek opposite the crown of the upper
second molar tooth. Numerous labial and buccal glands (mucous) situated in the submucosa of
the lips and cheeks open into the vestibule. Four or five molar glands (mucous), situated on the
buccopharyngeal fascia also open into the vestibule. Except for the teeth, the entire vestibule
is lined by mucous membrane. The mucous membrane forms median folds that pass from the
lips to the gums, and are called the frenula of the lips.

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Lips

The lips are fleshy folds lined externally by skin and internally by mucous membrane. The
mucocutaneous junction lines the 'edge' of the lip, part of the mucosal surface is also normally
seen.
Each lip is composed of:
a. Skin.
b. Superficial fascia.
c. The orbicularis oris muscle.
d. The submucosa, containing mucous labial glands and blood vessels.
e. Mucous membrane.
The lips bound the oral fissure. They meet laterally at the angles of the mouth. The inner
surface of each lip is supported by a frenulum which ties it to the gum. The outer surface of the
upper lip presents a median vertical groove, the philtrum.
Lymphatics of the central part of the lower lip drain to the submental nodes; the lymphatics
from the rest of the lower lip pass to the submandibular nodes3.

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Cheeks (buccae)
The cheeks are fleshy flaps, forming a large part of each side of the face. They are continuous
in front with the lips, and the junction is indicated by the nasolabial sulcus (furrow) which
extends from the side of the nose to the angle of the mouth. 2 Each cheek is composed of:
a. Skin.
b. Superficial fascia containing some facial muscles, the parotid duct, mucous molar glands,
vessels and nerves.
c. The buccinator covered by buccopharyngeal and pierced by the parotid duct. d. Submucosa,
with mucous buccal glands. e. Mucous membrane. fascia
The buccal pad of fat is best developed in infants. It lies on the buccinator partly deep to the
masseter and partly in front of it.
The lymphatics of the cheek drain chiefly into the submandibular and preauricular nodes, and
partly also to the buccal and mandibular nodes4.

Oral Cavity Proper

It is bounded anterolaterally by the teeth, the gums and the alveolar arches of the jaws. The
roof is formed by the hard palate and the soft palate. The floor is occupied by the tongue
posteriorly, and presents the sublingual region anteriorly, below the tip of the tongue.
Posteriorly, the cavity communicates with the pharynx through the oropharyngeal isthmus
(isthmus of fauces) which is bounded superiorly by the soft palate, inferiorly by the tongue,
and on each side by the palatoglossal arches.

The sublingual region presents the following features.

a. In the median plane, there is a fold of mucosa passing from the inferior aspect of the tongue
to the floor of the mouth. This is the frenulum of the tongue.
b. On each side of the frenulum, there is a sublingual papilla. On the summit of this papilla,
there is the opening of submandibular duct.
c. Running laterally and backwards from the sublingual papilla, there is the sublingual fold
which overlies the sublingual gland. A few sublingual ducts open on the edge of this fold.
Lymphatics from the anterior part of the floor of the mouth pass to the submental nodes. Those
from the hard palate and soft palate pass to the retro- pharyngeal and upper deep cervical nodes.
The gums and the rest of the floor drain into the submandibular nodes5.

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Gums (gingivae)
The gums are the soft tissues which envelop the alveolar processes of the upper and lower jaws
and surround the necks of the teeth. These are composed of dense fibrous tissue covered by
stratified squamous epithelium.
Each gum has two parts

a. The free part surrounds the neck of the tooth like a collar.

b. The attached part is firmly fixed to the alveolar arch of the jaw. The fibrous tissue of the gum
is continuous with the periosteum lining the alveoli (periodontal membrane) 6.

Teeth

The teeth form part of the masticatory apparatus and are fixed to the jaws. In man, the teeth are
replaced only (diphyodont) in contrast with non-mammalian vertebrates where teeth are
constantly replaced throughout life (polyphyodont). The teeth of the first set (dentition) are
known as milk, or deciduous teeth, and the second set, as permanent teeth.
The deciduous teeth are 20 in number. In each half of each jaw, there are two incisors, one
canine, and two molars.

The permanent teeth are 32 in number, and consist of two incisors (Latin to cut) one canine
(Latin dog) two premolars (Latin millstone) and three molars in each half of each jaw.

Parts of a Tooth

Each tooth has three parts:

1 A crown, projecting above or below the gum.

2 A root, embedded in the jaw beneath the gum.
3 A neck, between the crown and root and surrounded by the gum.

Structure
Structurally, each tooth is composed of:

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 The pulp in the centre

 The dentine surrounding the pulp.
 The enamel covering the projecting part of dentine, or crown.
 The cementum surrounding the embedded part the dentine. of
 The periodontal membrane.

The pulp is loose fibrous tissue containing vessels, nerves and lymphatics, all of which
enter the pulp cavity through the apical foramen. The pulp is covered by a layer of tall columnar
cells, known as odontoblasts which are capable of replacing dentine any time in life.
The dentine is a calcified material containing spiral tubules radiating from the pulp cavity.
Each tubule is occupied by a protoplasmic process from one of the odontoblasts. The calcium
and organic matter are in the same proportion as in bone.
The enamel is the hardest substance in the body. It is made up of crystalline prisms lying
roughly at right angles to the surface of the tooth.
The cementum resembles bone in structure, but like enamel and dentine it has no blood
supply, nor any nerve supply. Over the neck, the cementum commonly overlaps the cervical
end of enamel; or, less commonly, it may just meet the enamel. Rarely, it stops short of the
enamel (10%) leaving the cervical dentine covered only by gum.
The periodontal membrane (ligament) holds the root in its socket. This membrane acts as a
periosteum to both the cementum as well as the bony socket.

Form and Function (crowns and roots)

The shape of a tooth is adapted to its function. The incisors are cutting teeth, with chisel-like
crowns. The upper and lower incisors overlap each other like the blades of a pair of scissors.
The canines are holding and tearing teeth, with conical and rugged crowns. These are better
developed in carnivores. Each premolar has two cusps and is, therefore, also called a bicuspid
tooth. The molars are grinding teeth, with square crowns, bearing four or five cusps on their
crowns.

The incisors, canines and premolars have single roots, with the exception of the first upper
premolar which has a bifid root. The upper molars have three roots, of which two are lateral
and one is medial. The lower molars have only two roots, an anterior and a posterior

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Eruption of Teeth

The deciduous teeth begin to erupt at about the sixth month, and all get erupted by the end of
the second year or soon after. The teeth of the lower jaw erupt slightly earlier than those of the
upper jaw. The approximate ages of eruption are given in. Blood supply of teeth-Both upper
and lower are supplied by branches of maxillary artery.

Nerve supply of teeth

The pulp and periodontal membrane have the same nerve supply as follows
The upper teeth are supplied by the posterior superior alveolar, middle superior alveolar, and
the anterior superior alveolar nerves. The lower teeth are supplied by the inferior alveolar nerve.

STAGES OF DEVELOPMENT OF DECIDUOUS TEETH

By 6th week of development, the epithelium covering the convex border of alveolar process
of upper and lower jaws become thickened to form C-shaped dental lamina, which projects into
the underlying mesoderm. Dental laminae of upper and lower jaws develop ten centres of
proliferation from which dental buds grow into underlying mesenchyme. This is the bud stage.
The deeper enlarged parts of the tooth bud are called enamel organ. The enamel organ of dental
bud is invaginated by mesenchyme of dental papilla making it cap shaped. This is the cap stage.
The dental papilla together with enamel organ is known as the tooth germ. The cell of enamel
organ adjacent to dental papilla cells get columnar and are known as ameloblasts. The
mesenchymal cells now arrange themselves along the ameloblasts and are called odontoblasts.
The two cell layers are separated by a basement membrane. The rest of the mesenchymal cells
form the "pulp of the tooth". This is the bell stage. Now ameloblasts lay enamel on the outer
aspect, while odontoblasts lay dentine on the inner aspect. Later ameloblasts disappear while
odontoblasts remain.
The root of the tooth is formed by laying down of layers of dentine, narrowing the pulp space
to a canal for the passage of nerve and blood vessels only. The dentine in the root is covered
by mesenchymal cells which differentiate into cementoblasts for laying down the cementum.
Outside this is the periodontal ligament connecting root to the socket in the bone.
Ectoderm forms enamel of tooth. Neural crest cells form dentine, dental pulp, cementum and
periodontal ligament.

Formation of permanent teeth

These develop from the dental buds arising from the dental lamina and lie on the medial side
of each developing milk tooth.

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Being the hardest and chemically the most stable tissues in the body, the teeth are selectively
preserved after death and may be fossilized. Because of this, the teeth are very helpful in
medicolegal practice for identification of otherwise unrecognizable dead bodies. The teeth also
provide by far the best data to study evolutionary changes and the relationship between
ontogeny and phylogeny
• Improper oral hygiene may cause gingivitis and suppuration with pocket formation between
the teeth and gums. This results in a chronic pus discharge at the margin of the gums. The
condition is known as pyorrhoea alecolaris (chronic periodontitis). Pyorrhoea is common cause
of foul breath for which the patient hardly ever consults a dentist because the condition is
painless.
• Decalcification of enamel and dentine with consequent softening and gradual destruction of
the tooth is known as dental caries. A caries tooth is tender on mastication
• Infection of apex of root (apical abscess) occurs only when the pulp is dead. The condition
can be recognized in a good radiograph.
• Irregular dentition is common in rickets and the upper permanent incisors may be notched;
the notching corresponds to a small segment of a large circle. In congenital syphilis, also the
same teeth are notched, but the notching corresponds to a large segment of a small circle
(Hutchinson's teeth). The third molar teeth also called wisdom teeth usually erupt between 18
and 20 years. These may not erupt normally due to less space and may get impacted causing
enormous pain.
• Time of eruption of the teeth helps in assessing the age of the person.
• The upper canine teeth are called as the "eye teeth" as these have long roots which reach up
to the medial angle of the eye. Infection of these roots may spread in the facial vein and even
lead to thrombosis of the cavernous sinus.
• The upper teeth need separate injections of the anaesthetic on both the buccal and palatal
surfaces of the maxillary process just distal to the tooth. The thin layer of bone permits rapid
diffusion of the drug up to the tooth.

HARD PALATE
It is a partition between the nasal and oral cavities. Its anterior two-thirds are formed by the
palatine processes of the maxillae; and its posterior one-third by the horizontal plates of the
palatine bones.
The anterolateral margins of the palate are continuous with the alveolar arches and gums. The
posterior margin gives attachment to the soft palate. The superior surface forms the floor of the
nose. The inferior surface forms the roof of the oral cavity.

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Vessels and Nerves

Arteries: Greater palatine branch of maxillary artery
Veins: Drain into the pterygoid plexus of veins.
Nerves: Greater palatine and nasopalatine branches of the pterygopalatine ganglion suspended
by the maxillary nerve.
Lymphatics: The lymphatics drain mostly to the upper deep cervical nodes and partly to the
retropharyngeal nodes,

SOFT PALATE
It is a movable, muscular fold, suspended from the posterior border of the hard palate. It
separates the nasopharynx from the oropharynx, and is often looked upon as traffic controller
at the crossroads between the food and air passages. The soft palate has two surfaces, anterior
and posterior; and two borders, superior and inferior. The anterior (oral) surface is concave and
is marked by a median raphe. The posterior surface is convex, and is superiorly with the floor
of the nasal cavity. Continuous The superior border is attached to the posterior border of the
hard palate, blending on each side with the pharynx. The inferior border is free and bounds the
pharyngeal isthmus. From its middle, there hangs a conical projection, called the uvula. From
each side of the base of the uvula (Latin small grape) two curved folds of mucous membrane
extend laterally and down- wards. The anterior fold is called the palatoglossal arch or anterior
pillar of fauces. It contains the palatoglossus muscle and reaches the side of the tongue at the
junction of its oral and pharyngeal parts. This fold forms the lateral boundary of the
oropharyngeal isthmus or isthmus of fauces. The posterior fold is called the palatopharyngeal
arch or posterior pillar of fauces. It contains the palatopharyngeus muscle. It forms the posterior
boundary of the tonsillar fossa, and merges inferiorly with the lateral wall of the pharynx.
Structure
The soft palate is a fold of mucous membrane containing the following parts: The palatine
aponeurosis which is the flattened tendon of the tensor veli palatini forms the fibrous basis of
the palate. Near the median plane, the aponeurosis splits to enclose the musculus uvulae. The
levator veli palatini and the palatopharyngeus lie on the superior surface of the palatine
aponeurosis. The palatoglossus lies on the inferior or anterior surface of the palatine
aponeurosis. Numerous mucous glands, and some taste buds are present.

Muscles of the Soft Palate

 Tensor palati (tensor veli palatini).
 Levator palati (levator veli palatini).
 Musculus uvulae.
 Palatoglossus.
 Palatopharyngeus

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Nerve Supply

All muscles of the soft palate except the tensor veli palatini are supplied by the pharyngeal
plexus The fibres of this plexus are derived from the cranial part of the accessory nerve through
the vagus. The tensor veli palatini is supplied by the mandibular nerve.
General sensory nerves are derived from the middle and posterior lesser palatine nerves,
which are branches of the maxillary nerve through the pterygopalatine ganglion. The
glossopharyngeal nerve.
Special sensory or gustatory nerves carrying taste sensations from the oral surface are
contained in the lesser palatine nerves. The fibres travel through the greater petrosal nerve to
the geniculate ganglion of the facial nerve and from there to the nucleus of the tractus solitarius.
Secretomotor nerves are also contained in the lesser palatine nerves. They are derived from the
superior salivatory nucleus and travel through the greater petrosal nerve.
Movements and Functions of the Soft Palate
The palate controls two gates, upper air way or the pharyngeal isthmus and the upper food way
or oropharyngeal isthmus. The upper air way crosses the upper food way (Fig. 14.10). The soft
palate can completely close them, or can regulate their size according to requirements. Through
these movements, the soft palate plays an important role in chewing, swallowing, speech,
coughing, sneezing, etc. A few specific roles are given below.
1 It isolates the mouth from the oropharynx during chewing, so that breathing is unaffected
2 It separates the oropharynx from the nasopharynx by locking Passavant's ridge during the
second stage of swallowing, so that food does not enter the nose.
3 By varying the degree of closure of the pharyngeal isthmus, the quality of voice can be
modified and various consonants are correctly pronounced.
4 During sneezing, the blast of air is appropriately divided and directed through the nasal and
oral cavities without damaging the narrow nose. Similarly, during coughing, it directs air and
sputum into the mouth and not into the nose.

Blood Supply
Arteries
Greater palatine branch of maxillary artery
Ascending palatine branch of facial artery
Palatine branch of ascending pharyngeal artery

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Veins
They pass to the pterygoid and tonsillar plexuses of veins.

Lymphatics
Drain into the upper deep cervical and retropharyngeal lymph nodes.

Tongue
The tongue is a muscular organ situated in the floor of the mouth. It is associated with the
functions of
(i) taste,
(ii) speech
(iii) chewing
(iv) deglutition

PARTS
The tongue has:
 A root
 A tip
 A body, which has:
a. A curved upper surface or dorsum.
b. An inferior surface.

The dorsum is divided into oral and pharyngeal parts by a V-shaped, the sulcus terminalis. The
inferior surface is confined to the oral part only. The root is attached to the styloid process and
soft palate above, and to mandible and the hyoid bone below. Because of these attachments,
we are not able to swallow the tongue itself. In between the mandible and hyoid bones, it is
related to the geniohyoid and mylohyoid muscles. The tip of the tongue forms the anterior free
end which, at rest, lies behind the upper incisor teeth The dorsum of the tongue is convex in all
directions. It is divided into:
• An oral part or anterior two-thirds.
• A pharyngeal part or posterior one-third, by a faint V-shaped groove, the sulcus terminalis.
The two limbs of the 'V' meet at a median pit, named the foramen caecum. They run laterally
and forwards up to the palatoglossal arches. The foramen caecum represents the site from

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which the thyroid diverticulum grows down in the embryo. The oral and pharyngeal parts of
the tongue differ in their development, topography, structure, and function.
• Small posterior most part

The oral or papillary part of the tongue is placed on the floor of the mouth. Its margins are
free and in contact with the gums and teeth. Just in front of the palato- glossal arch, each margin
shows 4 to 5 vertical folds, named the foliate papillae. The superior surface of the oral part
shows a median furrow and is covered with papillae which make it rough. The inferior surface
is covered with a smooth mucous membrane, which shows a median fold called the frenulum
linguae. On either side of the frenulum, there is a prominence produced by the deep lingual
veins. More laterally there is a fold called the plica fimbriata that is directed forwards and
medially towards the tip of the tongue.
The pharyngeal or lymphoid part of the tongue lies behind the palatoglossal arches and the
sulcus terminalis. Its posterior surface, sometimes called the base of the tongue, forms the
anterior wall of the oropharynx. The mucous membrane has no papillae, but has many
lymphoid follicles that collectively constitute the lingual tonsil. Mucous glands are also
present.
The posteriormost part of the tongue is connected to the epiglottis by three-folds of mucous
membrane. These are the median glossoepiglottic fold and the right and left lateral
glossoepiglottic folds. On either side of the median fold, there is a depression called the
vallecula. The lateral folds separate the vallecula from the piriform fossa
• Glossitis is usually a part of generalized ulceration of the mouth cavity or stomatitis. In certain
anaemias, the tongue becomes smooth due to atrophy of the filiform papillae.
• The presence of a rich network of lymphatics and of loose areolar tissue in the substance of
the tongue is responsible for enormous swelling of the tongue in acute glossitis. The tongue
fills up the mouth cavity and then protrudes out of it.
• The undersurface of the tongue is a good site along with the bulbar conjunctiva for
observation of jaundice.
• In unconscious patients, the tongue may fall back and obstruct the air passages. This can be
prevented either by lying the patient on one side with head down (the 'tonsil position') or by
keeping the tongue out mechanically. • Lingual tonsil in the posterior one-third of tongue forms
part of Waldeyer's ring.

PAPILLAE OF THE TONGUE

These are projections of mucous membrane or corium which give the anterior two-thirds of the
tongue its characteristic roughness. These are of the following three types. Vallate or
circumvallate papillae: They are large in size 1-2 mm in diameter and are 8-12 in number. They
are situated immediately in front of the sulcus terminalis. Each papilla is a cylindrical
projection surrounded by a circular sulcus. The walls of the papilla have taste buds. The
fungiform papillae are numerous near the tip and margins of the tongue, but some of them are

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also scattered over the dorsum. These are smaller than the vallate papillae but larger than the
filiform papillae. Each papilla consists of a narrow pedicle and a large rounded head. They are
distinguished by their bright red colour. The filiform papillae or conical papillae cover the pre-
sulcal area of the dorsum of the tongue, and give it a characteristic velvety appearance. They
are the smallest and most numerous of the lingual papillae. Each is pointed and covered with
keratin; the apex is often split into filamentous processes. 4 Few foliate papillae are also
present.

MUSCLES OF THE TONGUE

A middle fibrous septum divides the tongue into right and left halves. Each half contains four
intrinsic and four extrinsic muscles.

Intrinsic Muscles
 Superior longitudinal
 Inferior longitudinal
 Transverse
 Vertical.

The intrinsic muscles occupy the upper part of the tongue, and are attached to the submucous
fibrous layer and to the median fibrous septum. They alter the shape of the tongue. The superior
longitudinal muscle lies beneath the mucous membrane. The inferior longitudinal muscle is a
narrow band lying close to the inferior surface of the tongue between the genioglossus and the
hyoglossus. The transverse muscle extends from the median septum to the margins. The vertical
muscle is found at the borders of the anterior part of the tongue
Extrinsic Muscles
 Genioglossus
 Hyoglossus
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 Styloglossus
 Palatoglossus
The extrinsic muscles connect the tongue to the mandible via genioglossus; to the hyoid bone
through hyoglossus; to the styloid process via styloglossus, and the palate via palatoglossus.

Arterial Supply of Tongue

It is derived from the tortuous lingual artery a branch of the external carotid artery. The root of
the tongue is also supplied by the tonsillar artery a branch of facial artery, and ascending
pharyngeal branch of external carotid. The lingual artery, and one vena comitant accompanies
the hypoglossal nerve. The deep lingual vein is the largest and principal vein of the tongue. It
is visible on the inferior surface of the tongue. It runs backwards and crosses the genioglossus
and the hyoglossus below the hypoglossal nerve. These veins unite at the posterior border of
the hyoglossus to form the lingual vein which ends in the internal jugular vein.

Lymphatic Drainage
The tip of the tongue drains bilaterally to the submental nodes. The right and left halves of the
remaining part of the anterior two-thirds of the tongue drain unilaterally to the submandibular
nodes. A few central lymphatics drain bilaterally to the deep cervical nodes. The posterior most
part and posterior one third of the tongue drain bilaterally into the upper deep cervical lymph
nodes including jugulodigastric nodes. The whole lymph finally drains to the jugulo-omohyoid
nodes. These are known as the lymph nodes of the tongue.

Nerve Supply
Motor Nerves
All the intrinsic and extrinsic muscles, except the palatoglossus, are supplied by the
hypoglossal nerve. The palatoglossus is supplied by the cranial root of the accessory nerve
through the pharyngeal plexus. So, seven out of eight muscles are supplied by XII nerve
Sensory Nerves
The lingual nerve is the nerve of general sensation and the chorda tympani is the nerve of taste
for the anterior two-thirds of the tongue except vallate papillae. The glossopharyngeal nerve is
the nerve for both general sensation and taste for the posterior one-third of the tongue including
the circumvallate papillae. The posterior most part of the tongue is supplied by the vagus nerve
through the internal laryngeal branch.

• Carcinoma of the tongue is quite common. The affected side of the tongue is removed
surgically. All the deep cervical lymph nodes are also removed, i.e., block dissection of neck
because recurrence of malignant disease occurs in lymph nodes. Carcinoma of the posterior
one-third of the tongue is more dangerous due to bilateral lymphatic spread.

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• Genioglossus is the only muscle of the tongue which protrudes it forwards. It is used for
testing the integrity of hypoglossal nerve. If hypoglossal nerve of right side is paralysed, the
tongue on protrusion will deviate to the right side. Normal left genioglossus will pull the base
to left side and apex will get pushed to right side (apex and base lie at opposite ends.

Muscles of mastication
Masseter, Temporalis, Lateral pterygoid and Medial pterygoid. Buccinator is a thin muscle
that hold each cheek towards the teeth while the lateral pterygoid is a fan shaped muscle which
helps jaw open during brushing.

Salivary Glands
A salivary gland is any cell or organ discharging secretion in to oral cavity. Saliva
is a fluid that is continuously secreted in to mouth. Saliva cleanses the mouth, dissolves food
particle so that they can be tasted, moisten food and aids in compacting it in to bolos, contains
enzyme that begin chemical breakdown of starchy food.
There are 3 pairs of salivary glands which lie outside the oral cavity and empty their
secretion into it they are parotid, submandibular, and sub lingual glands.
Parotid gland is largest gland lie anterior to ear, it runs parallel to the zygomatic arch
pierces buccinatar muscle and opens in to vestibule, sub mandibular gland lies along the medial
aspect of the mandibular body. It runs beneath the mucosa of oral cavity floor and opens at the
base of the lingual frenulum. The small sublingual gland lies anterior to the submandibular
gland under the tongue. It opens via 10 to 12 ducts in to the floor of the mouth.

Saliva
Saliva (commonly referred to as spit) is an extracellular fluid produced and secreted by salivary
glands in the mouth. In humans, saliva is around 99% water, plus electrolytes, mucus, white
blood cells, epithelial cells (from which DNA can be extracted), enzymes (such as lipase and
amylase), antimicrobial agents (such as secretory IgA, and lysozymes) The enzymes found in
saliva are essential in beginning the process of digestion of dietary starches and fats. These
enzymes also play a role in breaking down food particles entrapped within dental crevices, thus
protecting teeth from bacterial decay. Saliva also performs a lubricating function, wetting food
and permitting the initiation of swallowing, and protecting the oral mucosa from drying out.
Production is estimated at 1500ml per day and researchers generally accept that during sleep
the amount drops significantly. In humans, the submandibular gland contributes around 70 to
75% of secretions, while the parotid gland secretes about 20 to 25%; small amounts are secreted
from the other salivary glands.
Functions
Saliva contributes to the digestion of food and to the maintenance of oral hygiene. Without
normal salivary function the frequency of dental caries, gum disease (gingivitis and

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periodontitis), and other oral problems increases significantly. Saliva limits the growth of
bacterial pathogens and is a major factor in sustaining systemic and oral health through the
prevention of tooth decay and the removal of sugars and other food sources for microbes.
Lubricant
Saliva coats the oral mucosa mechanically protecting it from trauma during eating, swallowing,
and speaking. Mouth soreness is very common in people with reduced saliva (xerostomia) and
food (especially dry food) sticks to the inside of the mouth.
Digestion
The digestive functions of saliva include moistening food and helping to create a food bolus.
The lubricative function of saliva allows the food bolus to be passed easily from the mouth into
the oesophagus. Saliva contains the enzyme amylase, also called ptyalin, which is capable of
breaking down starch into simpler sugars such as maltose and dextrin that can be further broken
down in the small intestine. About 30% of starch digestion takes place in the mouth cavity.
Salivary glands also secrete salivary lipase (a more potent form of lipase) to begin fat digestion.
Salivary lipase plays a large role in fat digestion in newborn infants as their pancreatic lipase
still needs some time to develop.

Role in taste
Saliva is very important in the sense of taste. It is the liquid medium in which chemicals are
carried to taste receptor cells (mostly associated with lingual papillae). People with little saliva
often complain of dysgeusia (i.e., disordered taste, e.g., reduced ability to taste, or having a
bad, metallic taste at all times). A rare condition identified to affect taste is that of 'Saliva
Hypernatrium', or excessive amounts of sodium in saliva that is not caused by any other
condition (e.g., Sjögren syndrome), causing everything to taste 'salty'.
Other
Saliva maintains the pH of the mouth. Saliva is supersaturated with various ions. Certain
salivary proteins prevent precipitation, which would form salts. These ions act as a buffer,
keeping the acidity of the mouth within a certain range, typically pH 6.2–7.4. This prevents
minerals in the dental hard tissues from dissolving. Saliva secretes carbonic anhydrase (gustin),
which is thought to play a role in the development of taste buds Saliva contains Epidermal
Growth Factor [EGF]. EGF results in cellular proliferation, differentiation, and survival. EGF
is a low-molecular-weight polypeptide first purified from the mouse submandibular gland, but
since then found in many human tissues including submandibular gland, parotid gland. Salivary
EGF, which seems also regulated by dietary inorganic iodine, also plays an important
physiological role in the maintenance of oro-esophageal and gastric tissue integrity. The
biological effects of salivary EGF include healing of oral and gastroesophageal ulcers,
inhibition of gastric acid secretion, stimulation of DNA synthesis as well as mucosal protection
from intraluminal injurious factors such as gastric acid, bile acids, pepsin, and trypsin and to
physical, chemical and bacterial agents.

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Oral microflora

Oral microorganisms, including bacteria, archaea, fungi, viruses, and protozoa, are closely
associated with oral disease processes. A homeostatic balance is maintained between the host
and the oral microbial community through a variety of bidirectional communication and
regulatory mechanisms during a person’s life. However, oral infectious diseases, such as caries,
periodontal disease, and oral candidiasis, can be induced by the dysbiosis of the oral microbiota
in the past, the limitations of traditional pure culture techniques have meant that studies of the
oral microbiome focused mainly on bacteria. However, in recent years, with the development
of sequencing technologies and molecular investigative methods, oral fungi, the candidate
phyla radiation (CPR) group (a unique class of bacteria that co-parasitize the host), and viruses
are becoming hot topics in the ecology of the human oral microbiota.

Composition of the Oral Microbiota

There are about 1,000 species of bacteria in the oral cavity, mainly including the phyla
Actinobacteria, Bacteroidetes, Chlamydia, Euryarchaeota, Fusobacteria, Firmicutes,
Proteobacteria, Spirochaetes, and Tenericutes There are also a few lesser-known phyla and
candidate divisions in the oral cavity, including Chloroflexi, Chlorobi, GN02, Synergistetes,
SR1, TM7, and WPS-2 Among these, GN02, SR1, and TM7 belong to the CPR. Oral CPR
members are thought to influence the oral microbial ecology by modulating the structural
hierarchy and functions of the oral microbiome which have been shown to correlate with oral
diseases, such as periodontitis and halitosis However, the pure culture of the CPR is difficult,
and only TM7 had been cultured from the human oral cavity until November 2021.
There are approximately 100 species of fungi in the oral cavity. The common genera are
Aspergillus, Aureobasidium, Candida, Cladosporium, Cryptococcus, Fusarium, Gibberella,
Penicillium, Rhodotorula, Saccharomycetales, and Schizophyllum.It has been confirmed that
fungi account for 0.004% of the overall oral microorganisms and have only been detected in
specimens from the hard palate, supragingival plaque, and oral rinses.
The oral virome consists of eukaryotic viruses and phages. These eukaryotic viruses mainly
include Anelloviridae, Herpesviridae, and Papillomaviridae. In summary, the development of
DNA sequencing technologies and data analysis methods has greatly extended our
understanding of the oral microbiome, mycobiome, and virome. Oral microbiology is the study
of the microorganisms (microbiota) of the oral cavity and their interactions between oral
microorganisms or with the host.

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EXAMINATION OF ORAL CAVITY

The oral cavity is the goal of the diagnostic survey. It may reveal manifestation of the local
disease and signs of systemic diseases. The patient is asked to open the mouth widely and
examination conducted in bright light. The oral mucosa, teeth, tongue, gingiva, palate, pharynx,
tonsils and lips should be examined carefully.
ORAL MUCOSA
It should be examined carefully with a tongue depressor. It is normally pink and become bright
red in inflammatory conditions and pale in Anaemia. In the early or pre-eruptive stages of
Measles small bluish white spots (koplick's spots) opposite the molar teeth can be seen. In
Catarrhal Stomatitis, mucosa is red and there is increase exudation from mucous glands. It may
be due to improper oral hygiene, infectious disease or use of broad-spectrum antibiotics.
TEETH
On opening the mouth, the teeth are inspected. When the natural teeth are present, the
inspection should be made for their number, presence of any irregularities, cavities due to
caries. The cleanliness, staining, presences of tartar, exposure of the roots and the presence of
false teeth have to be noted. In Acromegaly, the teeth are widely spaced and the enlarged lower
jaw projected forward. In fluorosis the enamel is melted and the teeth are pitted and exhibit
brown staining. Due to Rickets, Cretinism, and malnutrition there will be delayed dentition.

COLOUR
Abnormal staining of teeth may be of two types, extrinsic and intrinsic. Extrinsic stains are
caused by chromogenic bacteria. Generalized discoloration of the enamel and dentin is more
likely to be due to intrinsic factors such as blood dyscarasias and drugs of tetracycline series.

TONGUE
COLOUR
Tongue is inspected by asking the patient to protrude it forwards. Normally the colour of the
tongue is pink or greyish red. And appears pale in Anaemia, blue in Cyanosis, yellow in
Jaundice, bright red in Pellagra, and Glossitis. There may be dark pigmentation of the tongue
in people taking iron preparation and in Addisson's disease. Raspberry tongue is seen in early
stage of scarlet fever characterized by scattered red dots on grey background, which is due to
red fungiform papillae sparsely dotted on grey tongue. Strawberry tongue is seen in later stage
of scarlet fever.

CLEANLINESS
The tongue may be cleaned or showed the presence of fur (coating). Fur consists of epithelial
cells, food particles and bacteria. It appears coated in pyrexial states, lack of oral hygiene,

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heavy smokers, constipation, and people on prolonged milk diet. In Typhoid the coating is
central and its tip and margins are free of fur.

DRYNESS AND MOISTURE

Normally the tongue is moist. It became dry in dehydration and in mouth breathers.

SIZE
It is bulky and large in Acromegaly, Hypothyroidism, and Cretinism. It appears small in states
of dehydration, starvation, and haemorrhages.

SURFACE
Normally the papillae are evident over the dorsum of the tongue. In conditions of Anaemia, the
papillae are atrophied and give a smooth bald appearance The tongue may show fissuring and
multiple small ulcers in congenital Glossitis and Stomatitis.

GINGIVA
The healthy gingiva is pink, firm, knife edged. They become pale in Anaemia, blue in Cyanosis,
and bright red when inflamed. In pregnancy it shows hypertrophy.

PALATE
Head should be tipped back slightly for direct observation of the shape, colour, and the presence
of any lesions, on the hard and soft palates. The consistency of deformities or swellings should
be investigated carefully by palpation. Colour changes may be caused by Neoplasms,
Infections and Systemic diseases.

PHARYNX AND TONSILS

To observe pharynx and tonsils area, the examiner must depress the tongue with either a mouth
mirror or a tongue depressor to note any colour change, ulcerations or swellings.

LIPS

The position and activity of the lips are important in controlling the degree of protrusion of the
incisors. With normal lips, the tips of maxillary incisors lie below the upper border of the lower
lip, and this arrangement helps to maintain the normal inclination of the incisor.

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ORAL HYGEINE PRACTISES

Ancient history

The ancient history of the world's fascination with oral health is a long and illustrious one.
Numerous dental epidemiological studies indicate that people are keeping their teeth longer
than ever before in this century. Neolithic age and prehistoric age people used agents and
devices that have evolved, by custom, myth, beliefs and by research, to enable people, with
professional assistance, to maintain good oral health. The first mentions of teeth and dental
hygiene were found in inscriptions from Mesopotamian clay tablets, so called 'oral hygiene
products' including toothpicks, chewing sticks, tooth powders and mouthwashes, dating back
to 5,000 years ago. The Egyptians, Mesopotamians', Greco-Romans, Hindus and Chinese
discovered variety of dental treatments and intricate surgical operations.
The intent of early humans was probably not to clean the teeth but simply to remove an
unpleasant subjective sensation. Later, they started keeping the mouth clean and healthy to
prevent oral diseases. The state of one's oral health, resulting from this practice or neglect is
also called oral hygiene. The aids and practices, which help in doing so, are called oral hygiene
practices.
A variety of oral hygiene measures have been used since before recorded history. This has
been verified by various excavations done all over the world, in which treatment for various
dental alignments, toothpicks, chew sticks, tree twigs, strips of linen, bird feathers, animal
bones and porcupine quills were discovered. Oral hygiene has been practiced for thousands of
years, with evidence for various oral hygiene products including toothpicks, toothbrushes,
tooth powders and mouthwashes, dating back to 7000 BC.
Oral hygiene is the practice of keeping one's oral cavity clean and free of disease and other
problems (e.g., bad breath) by regular brushing of the teeth (dental hygiene) and adopting good
hygiene habits. It is important that oral hygiene be carried out on a regular basis to enable
prevention of dental disease and bad breath.

Tooth brushing
Routine tooth brushing is the principal method of preventing many oral diseases, and perhaps
the most important activity an individual can practice to reduce plaque buildup. Controlling
plaque reduces the risk of the individual with plaque-associated diseases such as gingivitis,
periodontitis, and caries – the three most common oral diseases. The average brushing time for
individuals is between 30 seconds and just over 60 seconds. Many oral health care professionals
agree that tooth brushing should be done for a minimum of two minutes, and be practiced at
least twice a day. Brushing for at least two minutes per session is optimal for preventing the
most common oral diseases, and removes considerably more plaque than brushing for only 45
seconds.

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Tooth brush

The modern manual tooth brush is a dental tool which consists of a head of nylon bristles
attached to a long handle to help facilitate the manual action of tooth brushing. Furthermore,
the handle aids in reaching as far back as teeth erupt in the oral cavity. The tooth brush is
arguably a person's best tool for removing dental plaque from teeth, thus capable of preventing
all plaque-related diseases if used routinely, correctly and effectively. Oral health professionals
recommend the use of a tooth brush with a small head and soft bristles as they are most effective
in removing plaque without damaging the gums.
Toothbrushes typically consist of three parts:
• head: the working end that holds the bristles or filament
• handle: the part grasped by the hand during brushing
• shank: the section that connects the head to the handle
The head size of a toothbrush can range from 0.5 inches to 1.5 inches, giving individuals the
option to choose a comfortable size to fit the mouth. The American Dental Association (ADA)
guidance for head size recommends 1.25 inches in length, 2 to 4 rows of bristles, 5/16 to 3/8
inches in width, and 5 to 12 tufts/row.

Electric toothbrush
Electric toothbrushes are toothbrushes with moving or vibrating bristle heads. The two main
types of electric toothbrushes are the sonic type which has a vibrating head, and the oscillating-
rotating type in which the bristle head makes constant clockwise and anti-clockwise
movements. Electric toothbrushes are more expensive than manual toothbrushes and more
damaging to the environment.

Classification of brushing techniques based on the direction of toothbrush movement

1.Horizontal reciprocating motion:

 Horizontal Scrub Technique.
2.Vibratory motion:

 Bass (Sulcular) brushing technique.

 Stillman’s brushing technique.
 Charters brushing technique.
3.Vertical sweeping brushing technique:
 Modified Bass brushing technique.
 Modified Stillman’s brushing technique.

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 Leonard brushing technique.

 Hirschfeld’s brushing technique.
 Smith-Bell (Physiologic) brushing technique.
4.Rotary brushing technique:

 Fones Technique.
5. Horizontal reciprocating motion
6. Vibratory motion

 Horizontal Scrub Technique:

This is the most commonly used brushing technique due to ease of using. In this technique
the bristles are placed at a right angle to the long axis of the teeth and gentle horizontal
scrubbing movement of the brush is performed. The main advantage of this brushing technique
is its simplicity. However, a major disadvantage of this brushing technique is cervical abrasion
of teeth, which is particularly seen in patients who do vigorous brushing and/or use hard tooth-
brushes

 Bass (Sulcular) brushing technique:

Place the head of the brush covering three to four teeth, beginning at the most distal tooth in
the arch. Bristles are placed at the gingival margin, establishing an angle of 45 degrees to the
long axis of the teeth. Gentle vibratory pressure is exerted using short back and forth motions
without dislodging the tips of the bristles. Approximately 20 strokes are completed in the same
position. This motion forces the bristle ends into the gingival sulcus area as well as partially
into the interproximal embrasures (V- shaped valleys between adjacent teeth). The pressure
should produce perceptible blanching of the gingiva. Then brush is moved to the adjacent teeth
and the same process is repeated in the next three or four teeth. The same method is used to
brush the lingual surface also. Then brush is moved to the mandibular arch and brushing is
done in the same manner until the entire dentition is completed.
Advantages
 Removes the plaque in cervical sulcus and interproximal portions of the teeth
 Small areas are covered at a time.
 Easy to learn.
 Indicated for those who had undergone periodontal surgery.
 Good gingival stimulation
Disadvantages:
The disadvantage of this brushing technique is that the patient has to place the brush in many
different positions to cover the full dentition. Hence, the patient may lose patience while

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performing this brushing technique. To overcome this problem, the patient should be instructed
to brush in a controlled and systematic sequence for optimum plaque removal.

Stillman method
Technique
Place the bristle ends resting partly on the cervical portion of the teeth and partly on the adjacent
gingiva, pointing in an apical direction and at an oblique angle to the long axis of the teeth.
Apply pressure against gingival margin to produce a perceptible blanching Move the brush
about 20 short back and forth strokes while simultaneously moving it coronally along the
attached gingiva, the gingival margin and the tooth surface Reposition and repeat the stroke for
each group of teeth on all surfaces. To reach the lingual surfaces of the maxillary and
mandibular incisors, the handle of the brush can be held in a vertical position.
Advantages
 Bacterial plaque removal from cervical areas and from exposed proximal surfaces,
 Inter proximal area is cleaned.
 Moderate effort is required.
 Indicated in progressive gingival recession.

Disadvantages
 Bristle don't enter the sulcus
 Circular area is not cleaned


Charter’s brushing technique:

This brushing technique of tooth-brushing was recommended by Charter in 1848 83. It is a
very useful technique for patients having fixed prosthodontic or orthodontic appliances and in
patients who recently underwent periodontal surgery. In this brushing technique, the brush is
placed at an angle of 45⁰ to the long axis of the teeth in an opposite direction as recommended
in Bass technique, i.e., the bristles are directed coronally. After adaptation of the brush in place,
the bristles point away from the gingiva but towards the interproximal surfaces of the teeth.
After placing the bristles at the gingival margin, short back and forth vibratory strokes are
given. The bristles of the brush are then pressed on the occlusal surfaces of the teeth and using
a slight rotary motion, pits and fissures are cleaned.

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Vertical sweeping brushing technique

Modified Bass brushing technique

The modified Bass technique is same as the Bass technique with one additional movement of
the bristles. After the vibratory motion has been completed in each area, the bristles are swept
in rolling motion towards the occlusal surface. The indications are the same as discussed earlier
under Bass technique.
Advantages
This technique allows the removal of plaque and debris from the sulcular and interdental areas.
Along with this, the rolling motion completely cleans the buccal and lingual surfaces of the
teeth without damaging the base of the gingival sulcus. This technique is recommended for
patients with healthy gingiva without the recession of gingival margins.

Disadvantages
This technique is difficult to master and repeated patient reinforcement is required.

Modified Stillman’s brushing technique:

The technique is same as described in Stillman’s technique with the addition of a sweeping
movement of the bristles in a coronal direction. The technique is indicated in patients with
gingival recession, as it provides good gingival massage. Indications are the same as discussed
in Stillman’s technique.

Advantages:
This technique offers good gingival massage and inter-proximal cleaning.

Disadvantages:

The technique is difficult to learn and implement.

Leonard brushing technique

It is a vertical tooth brushing technique where the brush is moved up and down across the teeth.
The maxillary and mandibular teeth are brushed separately. After bringing the upper and lower

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teeth in edge-to-edge contact, the bristles are placed at a right angle to the long axis of the teeth
and are moved in up and down stroke motion. It must be noted that the upper and lower teeth
are not brushed in the same stroke. The teeth are placed in edge-to-edge contact to avoid
slipping of the brush over the incisal or occlusal surfaces. Pressure, enough to force the
filaments into the interdental areas is applied, but soft tissue should not be injured by excessive
pressure. This technique is not as efficient in plaque removal as the modified Bass or modified
Stillman’s technique.

Hirshfeld’s brushing technique:

This brushing technique is essentially the same as the Charter’s technique except that the
maxilla and mandible are kept occluded. It provided additional stability and control for those
patients who lack manual dexterity. The cheeks help in exerting pressure required to flex the
bristles.

Smith-Bell (Physiologic) brushing technique:

This is also known as the physiological technique of tooth-brushing because the brushing
method is the same as that taken by the food during mastication. The bristles are placed at the
height of the incisal edge or occlusal surfaces at an angle of 90 degrees and moved in the
gingival direction. This brushing technique produces frictional action similar to that obtained
from mastication of fibrous food. This brushing technique is suitable for patients having
anatomically normal dentition. It stimulates the gingiva and improves blood circulation in the
connective tissue. However, in the existing pockets, this brushing technique tends to strip the
tissue away from the teeth and facilitates packing of debris into the open pocket.

Rotary brushing technique

Fones Technique:
This method is usually recommended for young children with minimal manual dexterity. The
technique is quite easy to learn and provides good gingival stimulation. In this technique, the
brush is placed against a set of teeth and is moved in a circular motion 4-5 times for each set
of teeth. The maxillary and mandibular teeth are kept in occluded position while performing
this brushing technique. This technique is simple to use, but is less effective than modified Bass
and modified Stillman’s technique in plaque and debris removal.
Sequence of brushing
The recommended procedure for brushing is to start brushing from molar region of one arch
and then moving towards the opposite molar region of the same arch. Then the lingual surfaces
of the same arch are cleaned. The same procedure is followed on the opposite arch until all the
accessible areas of the dentition are cleaned. The last surfaces to be brushed are the occlusal
surfaces.

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Brushing duration
The length of time for which one brushes teeth varies from person to person depending on the
technique of brushing and the manual dexterity. Initially, when a tooth-brushing technique is
instructed to a patient, usually 10-20 minutes brushing time is required until the patients learn
the technique. Once the patient adapts to the technique, 3-5 minutes are sufficient for brushing.

Cleaning and storing tooth brush

A clean toothbrush is the primary requirement for the maintenance of good oral health. The
toothbrush should be rinsed with hot water before and after brushing the teeth. The thumb
should be placed over the bristles and moved back and forth with light pressure underneath or
in water. This procedure should be done both before and after tooth-brushing because many
airborne bacteria and other particles such as dust may have settled on the toothbrush since the
last brushing. The brush should be kept in a dry place which is well ventilated so that its bristles
dry soon after brushing. A dry environment is not conducive for the growth of many bacteria
and fungi.

Interdental hygiene

Interdental cleaning or interproximal cleaning is part of oral hygiene where the aim is to clean
the areas in between the teeth, otherwise known as the proximal surfaces of teeth. This is to
remove the dental plaque in areas a toothbrush cannot reach. The ultimate goal of interproximal
cleaning is to prevent the development of interproximal caries and periodontal disease. The
combined use of tooth brushing, and mechanical and manual interdental cleaning devices has
been proven to reduce the prevalence of caries and periodontal diseases.

Dental Floss
Floss is one of the most commonly used interdental cleaners. It is traditionally made of waxed
nylon wrapped up in a plastic box. Since dental floss is able to remove some inter-proximal
plaque, frequent regular dental flossing will reduce inter-proximal caries and periodontal
disease risks.
Various dental flosses are commonly used in many forms, including waxed, unwaxed
monofilaments and multifilament. Dental floss that is made of monofilaments coated in wax
slides easily between teeth, does not fray and is generally higher in cost than its uncoated
counterparts. The most important difference between available dental flosses is thickness.
Waxed and unwaxed floss are available in varying widths.

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Factors to consider in choosing a floss include the amount of space between teeth and user
preference. Dental tape is a type of floss that is wider and flatter than conventional floss. Dental
tape is recommended for people with larger tooth surface area. The ability of different types
of dental floss to remove dental plaque does not vary significantly; the least expensive floss
has essentially the same impact on oral hygiene as the most expensive.
Factors to be considered when choosing the right floss or whether the use of floss as an
interdental cleaning device is appropriate may be based on
 The tightness of the contact area: determines the width of floss
 The contour of the gingival tissue
 The roughness of the interproximal surface

Floss threader

A floss threader is loop of fibre that is shaped in order to produce better handling characteristics.
It is (similar to fishing line) used to thread floss into small, hard to reach sites around teeth.
Threaders are sometimes required to floss with dental braces, fix retainers, and bridge.

Floss-pick

A floss pick is a disposable oral hygiene device generally made of plastic and dental floss. The
instrument is composed of two prongs extending from a thin plastic body of high-impact
polystyrene material. A single piece of floss runs between the two prongs. The body of the floss
pick generally tapers at its end in the shape of a toothpick. There are two types of angled floss
picks in the oral care industry, the Y-shaped angle and the F-shaped angle floss pick. At the
base of the arch where the "Y" begins to branch there is a handle for gripping and manoeuvring
before it tapers off into a pick. Floss picks are manufactured in a variety of shapes, colours and
sizes for adults and children. The floss can be coated in fluoride, flavour or wax.

Interdental Brush

Interdental Brushes, also called interproximal brushes are oral hygiene instruments used to
clean the interdental spaces (space between teeth, brackets, bridges or implants). Their shape
is usually cylindrical and much smaller than a normal toothbrush.

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Types of interdental brushes

These vary mainly according to their thickness. Each colour indicates the diameter of the brush.
Classification of interdental brushes according to size and colour
According to the standard they are color-coded:

 Pink 0.4 mm.

 Orange 0.45 mm (PHD: <= 0.8 mm).
 Red 0.5 mm (PHD: 0.9-1.0 mm).
 Blue 0.6 mm (PHD: 1.1-1.2 mm).
 Yellow 0.7 mm (PHD: 1.3-1.5 mm).
 Green 0.8 mm (PHD: 1.6-1.8 mm).
 Violet 1.1 mm (PHD: >1.9 mm).
 Grey 1.3 mm.
 Black 1.5 mm.
Space or size between the teeth (PHD: Passage Hole Diameter).
They also vary in shape:
 Conic (pine-shaped): Especially for the hygiene of implants and around orthodontic
appliances.
 Straight or cylindrical: Special for lingual surfaces and spaces between the teeth.
 Thin: Easily adapts to small spaces.
 Ultrathin: For very narrow interdental spaces.

Indications for interdental brushes

Any patient who cannot completely remove residues with a conventional toothbrush should
use the interdental brush to control the formation of plaque on the teeth, especially people with:
 Open Interdental spaces
 Gingivitis and halitosis.
 Implants
 Prosthesis
 Orthodontic treatment

Bleeding of the gums is one of the disadvantages of using these brushes, but this is not a
problem, the bleeding will disappear in one or two weeks if the correct size is used for each
interdental space

Wooden or plastic triangular sticks

Inter proximal cleaning can be facilitated using sticks made of wood or plastic These sticks are
triangular in cross section to slide easily between teeth and reduce potential tissue trauma. The
stick is inserted inter proximally from buccal aspect with the flat surface, the base of the

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triangle, resting on gingival. The tip of the stick is angle coronally and is moved in a
buccolingual direction. A softer stick can be more easily adapted to the interproximal surface.
The stick should be discarded if the wood becomes sprayed as splinters could be forced in to
the gingival tissues.

Flossing methods

There are two flossing methods available to teach your patients. One is the circle or loop
method and the other is the spool method.

The circle or loop method

It is preferred for children or a patient with low manual dexterity. A piece of floss
approximately 18-24 inches long is tied at the ends to form a loop or circle. The patient uses
the thumb and index finger of each hand in various combinations to guide the floss
interproximally through the contacts. When inserting floss, it is gently eased between the teeth
with a seesaw motion at the contact point, making sure not to snap the floss and cause trauma
to the gingival papilla. Once through the contact area, gently slide the floss up and down the
mesial and distal marginal ridges in a C-shape around the tooth directing the floss subgingivally
to remove the debris.

The spool method

This utilizes a piece of floss approximately 18-24 inches long where the majority of the floss
is loosely wound around the middle finger of one hand and a small amount of floss around the
middle finger of the opposite hand. The same procedure is followed as the loop method when
positioning the floss interproximally. After each marginal ridge is cleaned, the used floss is
moved or spooled to the other hand until all supragingival and subgingival areas have been
cleaned, including the distal areas of the posterior teeth.

Oral irrigator

An oral irrigator (also called a dental water jet, water flosser or, by the brand name of the best-
known such device, Waterpik) is a home dental care device which uses a stream of high-
pressure pulsating water intended to remove dental plaque and food debris between teeth and
below the gum line. Regular use of an oral irrigator is believed to improve gingival health. The
devices may also provide easier cleaning for braces and dental implants. After filling the
reservoir with water, point the nozzle close to the gum line at an angle of 90 degrees. Then start

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the device by setting the appropriate pressure value. It is recommended to start irrigation from
the back teeth, slowly following the gum line. The water jet should be directed between the
tooth spaces, surfaces above the gum line, stopping momentarily at the area to be cleaned. In
the case of hard-to-reach areas such as when using braces, in gum pockets, the angle of the
nozzle can be changed.

Dentifices

Dentifrices, including toothpowder and toothpaste, are agents used along with a toothbrush to
clean and polish natural teeth. They are supplied in paste, powder, gel, or liquid form. Many
dentifrices have been produced over the years, some focusing on marketing strategies to sell
products, such as offering whitening capabilities. The most essential dentifrice recommended
by dentists is toothpaste which is used in conjunction with a toothbrush to help remove food
debris and dental plaque.
Factors governing selection of dentifrices:

 Proportionate fluoride content

 Less abrasiveness
 Desensitization effect
 Maintenance of gingival health

Components of dentrifices

Component Concentration (%)

 Abrasive - 20-50%
 Humectants- 20-40%

 Preservatives-0.05-0.5%
 Binding agent-1-3%
 Foaming agent-1-3%
 Flavouring agent - 1-2%
 Sweetening agent- 1-2%
 Therapeutic agent - 0.4-1%

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Types of dentrifices

Tooth paste

Toothpaste is a paste or gel dentifrice used with a toothbrush to clean and maintain the
aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it is an abrasive that
aids in removing dental plaque and food from the teeth, assists in suppressing halitosis, and
delivers active ingredients (most commonly fluoride) to help prevent tooth decay (dental
caries) and gum disease (gingivitis).

The essential components are an abrasive, binder, surfactant and humectant. Other ingredients
are also used. The main purpose of the paste is to help remove debris and plaque with some
marketed to serve accessory functions such as breath freshening and teeth whitening.

Tooth powder

The use of powdered substances such as charcoal, brick, and salt for cleaning teeth has been
historically widespread in India, particularly in rural areas. Modern tooth powder has been
positioned as a cost-effective substitute for toothpaste, as it can be applied with the index finger
without requiring use of a toothbrush.

Mouth wash

Mouthwash, mouth rinse, oral rinse, or mouth bath is a liquid which is held in the mouth
passively or swirled around the mouth by contraction of the perioral muscles and/or movement
of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the
back of the mouth.
Usually, mouthwashes are antiseptic solutions intended to reduce the microbial load in the
mouth, although other mouthwashes might be given for other reasons such as for their
analgesic, anti-inflammatory or anti-fungal action. Additionally, some rinses act as saliva
substitutes to neutralize acid and keep the mouth moist in xerostomia (dry mouth). Cosmetic
mouth rinses temporarily control or reduce bad breath and leave the mouth with a pleasant
taste. Rinsing with water or mouthwash after brushing with a fluoride toothpaste can reduce
the availability of salivary fluoride. This can lower the anti-cavity re-mineralization and
antibacterial effects of fluoride.

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Use

Common use involves rinsing the mouth with about 20–50 ml (2/3 fl oz) of mouthwash. The
wash is typically swished or gargled for about half a minute and then spat out. Mouthwash
should not be used immediately after brushing the teeth so as not to wash away the beneficial
fluoride residue left from the toothpaste. Similarly, the mouth should not be rinsed out with
water after brushing.

The most-commonly-used mouthwashes are commercial antiseptics, which are used at home
as part of an oral hygiene routine. Mouthwashes combine ingredients to treat a variety of oral
conditions. Variations are common, and mouthwash has no standard formulation, so its use and
recommendation involve concerns about patient safety.

Side effects:
(a) Temporary loss of taste.
(b) Burning sensation of mucosa.
(c) Dryness & soreness of mucosa.
(d) Epithelial desquamation.
(e) Discoloration of tooth, tongue and restorations.

Tongue cleaner

Tongue cleaner is used to remove microorganisms and debris and desquamated cells from
dorsum of tongue, available in metal and plastic form.
Cleaning the tongue as a part of oral hygiene is essential. Since it removes the white yellow
bad breath generating coating of bacteria, decaying food particle, fungi, and dead cells from
the dorsal area of tongue. It also removes some of the bacteria species which generate tooth
decay and gum problems. The dirt which is collected at the root of the tongue creates
obstruction in respiration, producing halitosis. Tongue cleaning helps to get rid of waste
products and bad odour of the mouth, improves taste sensation and exerts a tonic effect on the
tongue. Its value in preventing the diseases of mouth was realized by modern medicine only
recently.

Gum massage
These are substances which increase keratinization, mitotic activity and vascularity in
gingiva.

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ORAL DISEASES/ HEALTH EFFECTS OF POOR ORAL HYGEINE

Oral diseases are the most common non-communicable diseases and affect people throughout
their lifetime, causing pain, discomfort, disfigurement and even death. Oral health is a key
indicator of overall health, wellbeing and quality of life.
WHO defines oral health as "a state of being free from chronic mouth and facial pain, oral and
throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and
other diseases and disorders that limit an individual's capacity in biting, chewing, smiling,
speaking, and psychosocial wellbeing
The WHO Global Oral Health Status Report (2022) estimated that oral diseases affect close to
3.5 billion people worldwide, with 3 out of 4 people affected living in middle-income countries.
Globally, an estimated 2 billion people suffer from caries of permanent teeth and 514 million
children suffer from caries of primary teeth.
Prevalence of the main oral diseases continues to increase globally with growing urbanization
and changes in living conditions. This is primarily due to inadequate exposure to fluoride (in
the water supply and oral hygiene products such as toothpaste), availability and affordability
of food with high sugar content and poor access to oral health care services in the community.
Marketing of food and beverages high in sugar, as well as tobacco and alcohol, have led to a
growing consumption of products that contribute to oral health conditions and other NCDs.
Untreated dental caries (tooth decay) in permanent teeth is the most common health condition
according to the Global Burden of Disease 2019.

Dental caries (tooth decay/cavities)

Dental caries results when microbial biofilm (plaque formed on the tooth surface converts the
free sugars contained in foods and drinks into acids that dissolve tooth enamel and dentine over
time. With continued high intake of free sugars, inadequate exposure to fluoride and without
regular microbial biofilm removal, tooth structures are destroyed resulting in development of
cavities and pain. Although cavities are largely preventable, they are one of the most common
chronic diseases throughout the lifespan. Untreated tooth decay can lead to abscess under the
gums which can spread to other parts of the body and have serious, and in rare cases fatal.

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Classification of dental caries

1. According to location on individual tooth
(a) Pit and fissure caries
(b) Smooth surface caries
2. According to the rapidity of the process:
(a) Acute dental caries
(b) Chronic dental caries
3. According to the progress
(a) Recurrent caries
(b) Arrested caries

1(a) Pit and fissure caries:

Pits and fissures with high steep walls and narrow bases are most prone to develop carries.
They favour the retention of food debris and microorganisms and caries may result from
fermentation of food and formation of acid. The enamel bordering the pit or fissure may appear
opaque bluish white as it becomes undermined. This undermining occurs through lateral spread
of caries at the Dentino- Enamel Junction (DEJ). Thus, there may be a large carious lesion with
only a tiny point of opening.

(b) Smooth surface caries

It is generally preceded by the formation of a microbial or dental plaque. Proximal caries

usually begins just below the contact point and appears in the early stage as a faint white opacity
of the enamel without apparent loss of continuity of the enamel surface. The early white chalky
spot becomes slightly roughened, owing to superficial decalcification of the enamel. As the
caries penetrates the enamel, the enamel surrounding the lesion assumes a bluish white
appearance.

2(A) Acute dental caries

It is that form of caries, which runs a rapid clinical course and results in early pulp involvement
by the carious process. The process is so rapid that there is little time for the deposition of
secondary dentin.

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(b) Chronic dental caries

It is that form, which progresses slowly and tends to involve the pulp much later than acute
caries. The slow progress of the lesion allows sufficient time for both scleroses of the dentinal
tubules and deposition of secondary dentin in response to the adverse irritation. The carious
dentin is often stained deep brown. The cavity is generally a shallow one with a minimum
softening of dentin. There is little undermining and pain is not a common feature.

3(A) Recurrent caries:

It is that type of caries which occurs in the immediate vicinity of a restoration. It is usually due
to inadequate extension of the original restoration, which Favors retention of debris or to poor
adaptation of the filling material to the cavity, which produces a leaky margin. The renewed
caries follows the same general pattern as primary caries.

(B) Arrested caries:

It has been described as caries which becomes static or stationary and does not show any
tendency for further progression. It occurs almost exclusively in caries of occlusal surfaces and
is characterized by a large open cavity in which there is lack of food retention and in which,
the superficially softened and decalcified dentin is gradually burnished until it takes on a brown
stained, polished appearance and is hard. This has been referred to as 'Eburnation of Dentin'.
Nursing bottle caries is a type of rampant caries, affecting the deciduous dentition. There is
widespread carious destruction of deciduous teeth, most commonly the four maxillary incisors,
followed by the first molars and then the cuspids, if the habit is prolonged. It is the absence of
caries in the mandibular incisors which distinguishes this disease from ordinary rampant caries

Dental plaque

Dental plaque is a complex, metabolically interconnected, highly organized, bacterial

ecosystem. It is a structure of vital significance as a contributing factor to the initiation of the
carious lesion. An important part of dental plaque is acquired pellicle, which forms just prior
to or concomitantly with bacterial colonization and may facilitate plaque formation. However,
the presence of plaque does not necessarily mean that a carious lesion will develop at that point.
The microbiology of dental plaque includes three groups of microorganisms
namely,
 Streptococci

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 Actinomyces
 Veillonellae
Of all these, S. Mutans is considered to be the chief etiologic agent in dental caries.

Dental plaque is classified as

 Supragingival plaque (Marginal plaque)- found at or coronal to the gingival margin.

 Subgingival plaque- found apical to the gingival margin.

Formation of plaque
The initial colonization of microorganism on the tooth surface
probably begins with organisms other than Streptococcus mutans. There are three phases in the
formation of plaque.

 The formation of pellicle

 Initial adhesion and attachment of bacteria
 Colonization and plaque formation

The plaque formation continuous with the formation of extracellular

polysaccharides chains via the breakdown of sucrose to glucose and fructose. The chain of
glucose is called glucans and those of fructose are called fructans. These extracellular
polysaccharides are sticky, gelatinous substance that further enhances the bacterial ability to
adhere to the tooth and to each other. They also affect the rate at which saliva can enter the
plaque to buffer acids and reverse the demineralization process. This leads to further
accumulation of acids at which tooth plaque interface and when sufficient number of acids are
produced, there will be a drop in ph of plaque to critical level.
The quantity of plaque that forms on clean tooth surface during a
given time represents the net result of interaction among aetiologic factors, many internal and
external risk factors and protective factors such as

 The total oral bacterial population

 The quantity of the oral bacterial flora
 The anatomy and surface morphology of dentition
 The wettability and surface tension of the tooth surface
 The salivary secretion rate and other properties of saliva
 The intake of fermentable carbohydrate
 The mobility of tongue and lips
 The exposure of chewing forces and abrasion from food
 The eruption stage of the teeth

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 The degree of gingival inflammation and volume of gingival exudates.

Cocci predominates in plaque for the first two days following which rods and filamentous
organisms become involved. This is associated with increasing numbers of leucocytes in the
gingival margin. Between 6-10 days, if no cleaning has taken place, vibrios and spirochaetes
appear in plaque and this is associated with clinical gingivitis. It is generally felt that the move
towards a more gram negative anaerobic dense plaque is associated with the progression of
gingivitis and periodontal disease.

Dental calculus

Calculus (tartar) is a calcified deposit found on teeth and is formed by mineralization of plaque
deposits. It is a form of hardened dental plaque. Its rough surface provides an ideal medium for
further plaque formation, threating the health of gingiva. Once the tartar forms, it can be more
difficult to brush and floss the teeth effectively. The acid released by the bacteria in the mouth
are more likely to damage the tooth enamel. That leads to cavities and tooth decay. It can be
subdivided into two:
1. Supragingival calculus
2. Subgingival calculus

Supragingival calculus: Most often found opposite to the openings of the salivary ducts. It is
also called salivary calculus as it is formed from the saliva. It is creamy white or whitish yellow
in colour. It may get stained by tobacco or food or food pigments. It is hard and clay like in
consistency.
Subgingival calculus: It is found underneath the gingival margin and is firmly attached to tooth
roots. It tends to be brown or black, is extremely tenacious and is most often found on
interproximal and lingual surfaces. It may be identified visually, by touch using a calculus
probe, or on radiographs. With gingival recession, it can become supragingival.

Composition of calculus
Calculus contains of organic and inorganic components. 70% to 90% of the calculus is made
up of inorganic components and the rest form the organic fraction. Calculus is porous in
structure. The inorganic constituents are 75.9% calcium phosphate, 3.1% calcium carbonate,
traces of magnesium phosphate and trace elements like sodium, zinc, strontium, bromine,
copper, manganese, iron, fluorine etc. Calcium is the major constituent and forms about 19%.
Two thirds of the inorganic components are present in crystalline form. Different types of
crystals are present in calculus such as hydroxyapatite, magnesium whitlockite, octacalcium
phosphate and brushite.

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The organic content comprises of protein polysaccharide complexes,

desquamated epithelial cells, leukocytes and various type of microorganisms. Salivary proteins
account for 5.9% to 8.2% of the organic content. Carbohydrates form about 1.9% 9.1% and
lipids 0.2%
Mineralization of dental plaque results in calculus. Precipitation of mineral
salts into plaque starts between the first and the fourteenth day of plaque formation.
Microorganisms are not always essential for calculus formation. Calcification begins along the
inner surface of supragingival plaque and is formed in layers. Calculus formation continuous
until it reaches a maximum (10 weeks to 6 months) after which it reduces in amount due to
mechanical wear from food and from cheeks, lips and tongue.

Pathologic effects:
Calculus particularly, subgingival calculus is invariably associated with periodontal disease.
This may be because it is invariably covered by a layer of plaque. Its principal detrimental
effect is probably that it acts as a retention site for plaque and bacterial toxins. The presence of
calculus makes it difficult to implement adequate oral hygiene.

Dental calculus

HALITOSIS
Halitosis (Foul breath) is the disagreeable odour originate from oral or non-oral
sources. The main source of most halitosis is the oral cavity. Non-oral sources of breath odour
are generally related to systemic problems such as diabetes, liver and kidney disorders and
pulmonary diseases. Some medications that reduce salivary flow such as antidepressants,
antipsychotics, narcotics, decongestants, antihistamines and antihypertensive drugs and
disorders in the nose, sinuses, throat, lungs, oesophagus or stomach contribute towards non-
oral sources of breath odour. Sometimes, bad breath can be due to liver failure or ketoacidosis.
Concern about bad breath is the third most common reason people seek dental care, after tooth
decay and gum disease.

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The most common cause of bad breath is the food we eat. Garlic, onion, some
kinds of fish and diet rich in fats and meat can result in halitosis. When these foods are digested,
volatile substance or chemicals are absorbed into the blood stream and are carried to the lungs
where they are exhaled in breath. Oral based lesions caused by viral infections like herpes
simplex and HPV may also contribute to bad breath. The intensity of bad breath may differ
during the day, due to eating certain foods such as garlic, onion, meat, fish etc, smoking and
alcohol consumption. Halitosis patients were also shown to have significantly higher bacterial
loads in this region compared to individuals without halitosis.
Burning fat involves release of ketones that produces a foul smell through
breath, happens when the bodies are deprived of food, called ‘hunger breath’. The break down
product of protein used for energy and exhaled through lungs. Also, there is no flow of saliva
during sleep and putrefaction of saliva and debris in the mouth can lead to bad breath in the
morning.

For maintaining good oral hygiene,

 Brush teeth two times a day and floss once daily.
 Clean tongue before bed time by scraping with a tongue cleaner or brushing gently.
 Prevent hunger breath by eating regularly and avoiding fasting or skipping meals.
 Keep nose and sinus clean.
 Stimulate saliva flow with acidic fruits such as orange and lemon.
 Drink at least 8 glasses of water to keep mouth moist and help to rinse away odour
forming bacteria.

PERIODONTAL DISEASES

The main function of periodontium is to attach the tooth to the

bone tissues of the jaws and to maintain integrity of the surface of the masticatory mucosa of
the oral cavity. Periodontal diseases are one of the main chronic infectious diseases of the oral
cavity and the principal cause of tooth loss in humans47. It includes a group of chronic
inflammatory diseases that affect the supportive tissues of the teeth and encompass destructive
and non-destructive disease.
Periodontal diseases are of two main types:

 Those which attack the gingivae and are commonly described as ‘Gingivitis’.
 Those which involve chronic and progressive destruction of the periodontal membrane
and alveolus termed as ‘Periodontitis’.
Both gingivitis and periodontitis, if left untreated, can lead to tooth
loss. In the mildest form of the disease gingivitis, the gums redden, swell and bleed easily.
Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional
treatment and good oral home care whereas periodontal diseases are irreversible as these are

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progressive in nature with destruction of alveolar bone. Untreated gingivitis can advance to
periodontitis. With time, plaque can grow below the gum line. Toxins produced by the bacteria
in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the
body in essence turns on itself and the tissues and bone that support the teeth are broken down
and destroyed. Eventually the teeth become loose and may have to be removed. Periodontal
disease is almost universal in its occurrence affecting 95% of the population and is intimately
related to plaque and pocket formation. The prevalence is lower in children and young adults
with an estimated rate of 2% to 5% between the ages of 11 and 25 being affected.

Aetiology of periodontal disease

Local Factors

Deposits on teeth - Due to improper oral hygiene, deposits on teeth such as food debris, necrotic
tissue, supragingival calculus, material alba, mucinous plaque and dental stains can cause
gingival inflammation.
Microbial infection - The initial microbia of gingivitis consists of gram-positive rods, gram
positive cocci and gram-negative cocci. Gingivitis do not develop with normal bacterial flora
in oral cavity. Pathogenic flora acquired due to poor oral hygiene or overgrowth of normal
bacterial flora or pathogens coming from exogenous sources could lead to gingivitis.

Systemic factors

There is no evidence that systemic factors are a significant cause of periodontal disease. Some
hormonal, metabolic, genetic and nutritional variables may modify the progress of disease.

Risk factors in periodontal disease

Age: The prevalence of chronic inflammatory periodontal disease is found to be high in

children. A steady increase in prevalence has been noted as age advances.
Education: Periodontal disease is inversely related to increasing levels of education.
Place of residence: Periodontal disease are slightly higher in rural areas than in urban areas.
Diet: Vegetarians tend to consume more carbohydrate containing sticky foods. So, prevalence
and severity of periodontal disease is more evident among vegetarians.
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Oral hygiene status: Poor oral hygiene is an important risk factor in highly susceptible
individuals and is of less importance in individuals with strong host resistance.
Socio-economic factors: Several studies have shown that the lower income group have a
higher rate of periodontal disease than the higher income group. This is directly related to the
lower socioeconomic group not being able to afford the high cost of dental services and to other
factors such as poor diet, poor oral hygiene status and lack of dental awareness.

Oral cancer

Oral cancer includes cancers of lip and all subsites of the oral cavity, and oropharynx. The age-
adjusted incidence of oral cancer (cancers of the lip and oral cavity) in the world is estimated
at 4 cases per 100,000 people. However, there is wide variation across the globe: from no
recorded cases to around 20 cases per 100,000 people. Oral cancer is more common in men, in
older people, and varies strongly by socio-economic condition. In some Asian-Pacific
countries. the incidence of oral cancer ranks among the three top cancers Tobacco, alcohol and
areca nut (betel quid) use are among the leading causes of oral cancer. In regions like North
America and Europe, "high risk" human papillomavirus infections are responsible for a
growing percentage of Oro-pharyngeal cancers among young people.

Oral manifestations of HIV infection

Oral manifestations occur in 30-80% of people with HIV, with considerable variations
depending on the situations such as affordability of standard antiretroviral therapy (ART). Oral
manifestations include fungal, bacterial or viral infections of which oral candidiasis is the most
common and often the first symptom early in the course of the disease. Oral HIV lesions cause
pain, discomfort, dry mouth, eating restrictions and are a constant source of opportunistic
infection. Early detection of HIV-related oral lesions can be used to diagnose HIV infection,
monitor the disease's progression, predict immune status and result in timely therapeutic
intervention. The treatment and management of oral HIV lesions can considerably improve
oral health, quality of life and wellbeing.

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Prevention of oral diseases

The burden of oral diseases can be reduced through public health interventions by addressing
common risk factors These are

 Promoting a well-balanced diet

 Low in free sugars to prevent development of dental caries, premature tooth loss and
other diet-related NCD -With adequate fruit and vegetable intake, which may have a
protective role in oral cancer prevention -Reducing smoking, the use of smokeless
tobacco Including chewing of areca nuts, and alcohol consumption to reduce the risk of
oral cancers periodontal disease and tooth loss and

 Encouraging use of protective equipment in sports and when traveling in motor

vehicles, to reduce the risk of facial injuries

 Dental caries can be largely prevented by maintaining a constant low level of fluoride
in the oral cavity Optimal fluoride can be obtained from different sources such as
fluoridated drinking water, salt, milk and toothpaste Twice- daily tooth brushing with
fluoride-containing toothpaste (1000 to 1500 ppm) should be encouraged. Long-term
exposure to an optimal level of fluoride results in substantially lower incidence and
prevalence of tooth decay across all ages

 Oral health inequalities must be reduced by tacking the broader social determinants
through a range of complementary downstream, midstream and integrated upstream
policies such as water fluoridation regulation of the marketing and promotion of sugary
foods to children and taxes on sugar sweetened beverages. Moreover, promoting
healthy settings such as healthy workplaces and health promoting schools is critical to
building comprehensive supporting environments to promote oral health.

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Oral hygiene and systemic illness

Diabetic mellitus

Diabetes mellitus describes a group of disorders characterized by elevated levels of glucose in

the blood and abnormalities of carbohydrate, fat and protein metabolism. A number of oral
diseases and disorders have been associated with diabetes mellitus, and periodontitis has been
identified as a possible risk factor for poor metabolic control. Diabetes is believed to promote
periodontitis through an exaggerated inflammatory response to the periodontal microflora.
Patients with long-standing, poorly controlled diabetes are at risk of developing oral
candidiasis. Diabetic patients often suffer from dry mouth, which greatly increases their risk of
developing periodontal disease

Oral health and cardiovascular diseases

Several direct and indirect mechanisms have been proposed as pathophysiological links
between chronic periodontitis and atherosclerotic cardiovascular disease.6 Key concepts
include the interplay between periodontal pathogens, vascular endothelial damage and
atherogenesis. Systemic inflammation, with chronically elevated inflammatory markers, is
common to both disease processes, though to what extent anatomically remote sources of
inflammation interact in causative fashion is unclear.

Oral health in Alzheimer's disease

Alzheimer’s patients had worse oral health (caries and periodontal disease), more mucosal
lesions (cheilitis and candidiasis), and worse saliva quantity and quality. Patient could also
forget to brush teeth due to memory loss resulting in developing oral diseases rapidly

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ORAL HYGEINE/HEALTH ASSESSMENT TOOLS

ORAL HYGIENE INDICES

SIMPLIFIED ORAL HYGIENE INDEX(OHI-S)

The simplified oral hygiene index (OHI-S) was developed in 1964 by JOHN C. Greene and
jack R. Vermillion. Even though the oral hygiene index was determined be simple and sensitive,
it is time consuming and required more decision making. So, an effort was made to develop a
more simplified version with equal sensitivity.
The oral hygiene index consists of 2 components

1. Debris Index (DI)

2. Calculus Index (CI)

Each of these indices is representing the number of debris or calculus found on the buccal and
lingual surfaces of each dental arch- the maxillary and mandibular arches which is composed
of 3 segments each.

Segments

A) Maxillary arch
1. Segment 1: The segment distal to the right cuspid
2. Segment 2: Upper right canine to upper left canine
3. Segment 3: The segment distal to the left cuspid
B) Mandibular arch
1. Segment 4: The segment distal to the left cuspid
2. Segment 5: Lower left canine to lower right canine
3. Segment 6: The segment distal to the right cuspid

Rules of Oral Hygiene Index

1. Only fully erupted permanent teeth are scored

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2. Third molars and incompletely erupted teeth are not scored (because of the wide
variations in heights of clinical crowns)
3. From each segment, one tooth is used for calculating the individual index, for that
particular segment.
4. The tooth used for the calculation must have the greatest area covered by either debris
or calculus.
5. The oral hygiene examination and scoring for the Debris Index always should precede
the oral examination and scoring for the Calculus Index

Instruments Used-Mouth mirror. no. 23 explorer (Shepherd’s Hook)

DEBRIS INDEX- Simplified (DI-S)

The surface area covered by debris is estimated by running the side of an explorer
(shepherd’s Hook) along the tooth surface being examined. The occlusal or
incisal extend of debris is noted as it is removed.

SCORE CRITERIA

0 No debris or stain present

1 Soft debris covering not more than one third of the tooth
surface, or presence of extrinsic stains without other debris
regardless of surface area covered

2 Soft debris covering more than one third, but not more than
two thirds of the exposed tooth surface.

3 Soft debris covering more than two thirds of the exposed

tooth surface

CALCULUS INDEX SIMPLIFIED (CI-S)

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There are two main types of dental calculus, which are differentiated primarily by location on
the tooth in relation to the free gingival margin.

1. Supragingival calculus- denotes deposits, usually white to yellowish-brown in colour,

occlusal to the free gingival margin
2. Subgingival calculus-denotes deposits usually light brown to black in colour, apical to the
free gingival margin

Score Criteria
0 No calculus present
1 Supragingival calculus covering not more than one third of the
exposed tooth surface.
2 Supragingival calculus covering more than one third but not more than
two thirds of the exposed tooth surface or the presence of individual
flecks of subgingival calculus around the cervical portion of the tooth
or both.
3 Supragingival calculus covering more than two third of the exposed
tooth surface or a continuous heavy band of subgingival calculus
around the cervical of the tooth or both.

CALCULATION OF THE INDEX

For each individual, the debris and calculus scores are totalled and divided by the number of
tooth surfaces scored.

Calculation of DI-score - total score/ no of surfaces examined

Calculation of C1-S score - total score/ no. of surfaces examined

Once the DI-S and C1-S are calculated separately they are added together to get the OHI-S
Score

OHI-S = DI-S+CI-S

Uses of OHI-S score index

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 It has been widely used in studies of the epidemiology of periodontal disease.

 It is useful in evaluation of dental health education programs in public school systems
 It is used in evaluating the cleansing efficiency of tooth brushes.
 It is used to evaluate an individual's level of oral cleanliness

Interpretation of values for the DI-S and CI-S score

 Good-0.0-0.6

 Fair-0.7-1.8

 Poor-1.9-3.0

For the OHI-S score,

 Good -0.0-1.2

 Fair-1.3-3.0

 Poor-3.1-6.0

Higher the OHI, poorer is the oral hygiene of the patient.

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Beneficial foods for oral health

Cereals which are rich in vitamin B, fruits and vegetables containing

vitamin C contribute to healthy gums. Lean meat, fish and poultry provide magnesium and zinc
for teeth. Some of the best foods for healthy teeth are fresh fruits and veggies because of their
high nutritional value and added teeth cleaning benefits. There are calcium rich foods, such as
low fat or fat free milk, yogurt and cheese, dark leafy vegetables that help to promote strong
teeth and bones. Chewing on crunchy foods gets the saliva going, which along with water,
helps to wash away plaque causing bacteria and food particles.
Foods that help muscles and bones also help teeth and gums. Breads
and cereals are rich in vitamin B while fruits and vegetables contain vitamin C, both of which
contribute to healthy gum tissue. Lean meat, fish and poultry provide magnesium and zinc for
teeth. Fluoride is a primary protector against dental cavities and makes the surface of teeth
more resistant to acids during the process of remineralisation. Milk and cheese are also rich in
calcium and phosphate, and may also encourage remineralisation. All foods increase saliva
production and since saliva contains buffer chemicals which helps to stabilize the ph in the
mouth. Food high in fibre may also help to increase the flow of saliva.

Harmful foods
Sugars, carbohydrates especially cooked starches and sticky food may
also damage teeth. Acids contained in fruit juice and soft drinks lower the ph level of the oral
cavity which causes the enamel to demineralise. Drinking orange juice or cola throughout the
day raises the risk of dental cavities tremendously. Smoking and chewing tobacco are both
strongly linked with many dental diseases.

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AYURVEDIC VIEW

MUKHA SAREERAM

Mukha is considered as the gate way of mahasrotas, which is included among prathyangas and
one among nine bahirmukhasrotas. It is a part of uthamanga (superior organ) of body.
Bodhakakapha and pranavayu are the predominant doshas in mukha.

Nirukthi

- खनतितिदारयति अन्नातदकमनेन खन्यिे मु खमनेति िेति "

It means the structure that helps in breaking down of food materials into smaller particles.

Definition of mukha

ओष्टौ च दन्तमू लातन दन्त तिहा च

िालु च गलो मु खातद सकलं सप्ताङ्ग मु खमु च्यिे

According to Bhavamisra, the 2 oshtas (lips), a set of dantamoolas (gums) danta (teeth), jihwa
(tongue), talu (palate) and gala (throat) are collectively called Mukha
Acharya Charaka included different oral parts among pratyangas like sleshmambu (tonsils),
srikkini (angle of mouth), upajihwika (epiglottis), galashundi(uvula) etc.

Synonyms
Vadanam, Vaktram, Tundam, Asyam, Ananam, Lapanam

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 िदनम्

"िदन्त्यनेनेति
A part which helps in speaking.

 िक्त्रम्

उच्चिे अनेन इति िक्त्रम

This means the part that helps in speaking

 िु ण्डम्

िु डयिे तनष्पीडयति अभ्यन्तरस्य द्रव्यतमति ॥

Part which helps in the breaking down of food

 आस्यम्

अस्यिे यसोस्मिन इति असु क्षे पणे

Part which helps in swallowing

 आननम्

आतनति अनेन
Part which helps in breathing.

 लपनम्

लप्यिे अनेनेति
Part which helps in speaking
From the above explanations, it is clear that it is the part which helps in eating, speaking and
breathing.

Rasanabandhana and kanta are the 2 mugha avayavas included in the dasajeevithadhamas.
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Garbhasareera

During garbhaavastha, mukha is formed in the fifth month of intra uterine life.13

Pramanasareeram

Acharya Charaka mentioned 5 angula as the measurement of 'asya'" whereas Acharya Susruta
mentioned 4 angula as the "vadanantara pramana".

Mukha prathyangas (Anatomical parts of mukha)

Susruta, bhavaprakasha, yogaratnakara sarangadhara mentioned 7 subsites of mouth while

Vagbhata mentioned 8 including ganda

Oshta (lips)

These are two in number - urdhvaoshta (upper lip) and adharaoshta (lower lip). It is considered
as a mathruja bhava (maternal origin)
No of pesi (muscles)- 2

Gandam (Kapolam) - (Cheek)

They are two in number - dakshina and vama ganda.

Danta

According to Ayurveda, danta is the upadhathu of asthi.

Synonyms - दशन, रुचकातन, रदन "

There are two rows of teeth - Uttaradanta (upper teeth) and Adharadanta (lower teeth)

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No of asthi in dantham- 32
Type of asthi- Ruchaka
Types of sandhi- ulookhalam

Acharya Kasyapa, explained about dentition, which include number of teeth. its eruption,
development, types, ideal dentition and aprasasthadanta."
Number of teeths are as follows
Raja danta 4
Basta danta 4
Damstra danta 4
Swarudha danta 8
Hanavya danta 12
Total 32

Dantasampath (Ideal teeth)

Features of dantasampath (ideal teeth) are as follows.

 Poornatha (completeness)

 Samatha (evenness)

 Ghanatha (compactness)

 Suklatha (whiteness)

 Snigdhatha (unctuousness)

 Slakshnatha (lustrous)

 Nirmalatha (clarity)

 Niramayatha (without diseases)

 Kinchithuttaronnatha (slightly prominent)

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 Dantabanthanamsamatha (evenly placed in relation to each other)

 Raktata (redness)
 Brhathghanasthiramoolatha (strongly fixed to the gums)

Dantotpathiprakriya (Physiology of teeth eruption)

Detailed description of danta janma vidhi is found in Kasyapa Samhita.

According to Acharya Kasyapa, during intrauterine life the blood that collects in the pit of teeth,
by further development takes shape of teeth. It is said that teeth which is originate in the eighth
month is of best quality.
Details regarding tooth eruption as per Ayurveda (Danthajanmavidhi)
The whole process has been into following 6 steps.

1.Nishechana - Insemination
2.Murtarupa – Manifestation
3.Udbhava – Eruption
4.Purvarupa – Prodromal symptoms
5.Upadrava – Complication
6.Upakrama – Management

 Nishechana
Nishechana means appearance of the tooth in the infant.
 Murtarupa
Murtarupa means manifestation of the particular tooth. It is the duration for a tooth
to appear or manifest after it starts cutting the gums.
 Udbhava
Udbhava means complete eruption of the tooth.
 Upadrava
Upadrava means complications during teeth eruption process. Acharya
Vagbhata has described diseases such as jwara, bhrama, pothaki, swasa, sirovedana,
abhishayanda, vamana, atisara, trsna, kukunaka, visarpa and kasa.
 Upakrama

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According to Acharya Vagbhata, various dentition disorders subside automatically.

Eventhough strict regimen is not advised, specific treatment for these diseases is mentioned.
Massage of gum with different drugs as well as oral medication has been prescribed for diseases
due to eruption of teeth

Types of teeth eruption

Four types of teeth eruption are as follows:

 Samudga

 Samvrta

 Vivrta

 Dantasampat

1. Samudgam

In this type there is constant decaying and destruction of teeth.

2. Samvritam

It refers to the teeth which are enclosed by gums. Teeth are dirty and inauspicious. This
condition can be assessed as hypertrophied gums.

3. Vivritam

It refers to those teeth which are not covered by gums. There is excessive salivation and
discolouration of teeth. This condition can be correlated as atrophy of gums.
4. Dantasampath

Teeth which are normal and possessing the qualities of ideal teeth refers to dantasampath.

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Aprasasthadanta

Aprasasthadanta means imperfect teeth explained by Kasyapa has the

following features.

 Sadantajanma (natal teeth)

 Poorvamuttaradantajanma (first eruption of upper teeth)

 Viraladantajanma (scattered teeth)

 Heenadantata (presence of less number of teeth)

 Adhikadantata (presence of a greater number of teeth)

 Karaladantata (terrible teeth)

 Vivarnadantata (discoloured teeth)

Dantamoola (Gums)

Acharya Charaka has included dantaveshtaka under prathyangas. Gums related to upper and
lower jaw are two in number. According to Kasyapa dantamoola is developed from rakta dhatu.

Synonyms
Dantamamsam
Dantaveshtakam

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Dantabandhanam
Asthi in danthamoolam- 32 according to caraka
Asthisandhi- 32 according to susruta

Jihwa (Tongue)

It is the part which helps in the perception of taste i.e., rasa vishayagrahanam. It originates from
mamsa, rakta and kapha" i.e., from matruja bhavas and is the seat of rasanendriya (organ of
taste) and vaagindriya (organ of speech).

Synonyms
Gojihwa, Rasana, Rasajna

Acharya charaka described jihwa among pratyanga, Susruta explained siras related to jihwa
Number of pesi - 1 (susruta)
Number of siras- 36(susruta)

Talu (Palate)
Acharya Charaka mentioned talu as pratyanga and two bones take part in the formation
of talu and one according to Acharya Susrutha.

Gala (Throat)

Nirukthi-

' गलति भक्षयत्यनेन

That which helps in deglutition.

One among dasapranayathanas. Kanta and Gala compared to a certain extent as oropharynx.
Oropharynx include the side and back walls of the throat, the tonsils, the soft palate and the
back one third of the tongue. According to Susruthaacharya, there is one pesi in gala.
Charakaacharya has mentioned 10 pratyangas in which kanta is also included.

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Sakalam (Whole oral cavity)

Sakalam means the entire/ ‘whole’ ie, total of various sub organs, which are included
under the heading of mukha. While describing the disease of mukha, Susruthaacharya has
described 3 rogas as sarvasya roga.

KRIYA SAREERAM (AYURVEDIC PHYSIOLOGY)

Mukha is the sthana of bodhakakapha and pranavayu.

Mastication and digestion are the main function of mukha. Oshta, jihwa, gala and talu are
involved in producing sound also sensation of taste

ROLE OF TRIDOSHAS IN MUKHA SAREERA

Role of vata
Kanta is the gocharasthana of pranavayu. Pranavayu, located in siras performs the functions
of mukha such as shteevana (spitting), udgara (belching), annapravesa (deglutition).
Udanavayu (gocharasthana- gala) performs functions like vakpravriti (speech).

Vyanavayu.
The movement of food from oral cavity to stomach is controlled by vyana vayu
Anna aswadana is the function of Vyanavayu

Role of pitta
The unvitiated Pitta blesses the body with functions like ruchi (taste perception), pakthi
(digestion), kshut (appetite) and trishna (thirst)
Role of kapha
• Mukhangas like kanta and rasana constitutes the sthana of kapha. Bodhaka kapha, situated in
the jihwamoola and kanta lends its aid to the perception of tastes by maintaining the moist or
humid character (soumya bhava) of the tongue.

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ORAL HYGIENE PRACTICES

Ayurveda - the science of life, is rather a precious science which tells how life should
be lived in a better healthy way. It not only deals with curative measures of diseases but
also has developed unique regimes eg. ritucharya, dinacharya which its advices to be
followed by every individual in his daily routines. In the context of oral hygiene
ayurveda mentions certain dinacharya procedures. It starts with regimes right from one
getting up from bed. Dinacharya has a great role to play in maintaining proper oral
hygiene. Some of the measures for maintaining good oral hygiene are danthadhavanam,
gandusha, kabala, pratisaranam, jihwanirlekhanam, mukha prakshalanam,
thamboolacharvanam

DANTHADHAVANAM

Nirukthi

 "दन्तानां धािनम् ”

 “दन्तानां धािना यिाि् ”

It means cleans the teeth.

 The word Danta is composed of

दन्त =दम् + िन्

The root “दम् " which when suffixed by "िन्" gives rise to the word. It means
to tame or to tranquillize.

 The word Dhavanam is composed of

धािनम् = धाि् + ल्युट्

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It means some kind of material used for cleaning.

SYNONYMS

 Dantapavana

 Dantashodhana

 Dantashana

Procedure of danthadavana

Brush to be used

It is recommended to brush each tooth individually by koorcaka, which is a soft tooth brush
made from certain medicinal plants. It should be of 12 angulas in length and diameter of one's
own little finger. In each time fresh twigs must be taken from a tree grown in unpolluted area.
The tip of the stick should be crushed to make soft bristles and each tooth is to be brushed
smoothly.

Tooth cleaning stick may be selected according to the taste and properties required for
individuals in consideration of season as well as the doshas and nature of the body constituency.
Tooth brushing with the sticks of various tastes removes foul smell, tastelessness, dirt from
tongue and increase the taste sensation and bring freshness of mouth and thereby prevent
diseases of tooth, tongue and oral cavity.

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Way to use the brush

The tooth brush should be rotated over the gums and teeth in a vertical manner i.e., from below
upwards in the lower jaw and from above downwards in the upper jaw.

Timings for dantadhavana

The teeth should be brushed twice a day and washed thoroughly by

sitting comfortably with a relaxing mind and facing North or East directions.

Selection of drugs

As per Bhavamisra and Susrutha. the selection of twigs for tooth brush should be on the basis
of season, dosha, rasa and virva

Indicated rasa of the brushing twig

According to Vagbhata and Acharva Charaka", kashaya, katu, tikta are indicated rasa for
brushing twig. Acharya Susrutha and Bhavamisra" added madhura rasa in addition to this.

Drugs mentioned for danthadhavana

SL.NO DRUG CHARAKA SUSRUTA AH AS

NAME
1 Karanja + + + +
(Pongamia
pinnata)
2 Karaveera + - - +
(Nerium
indicum)
3 Arka + - + +
(Calotropis
gigantea)
4 Malathi + - - +
(Jasminum
grandiflorum)

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5 Kakubha + - + +
(Terminalia
arjuna)
6 Asana + - - +
(Pterocarpus
marsupium)
7 Nimba - + - -
(Azadirachta
indica)
8 Khadira - + + +
(Acacia
catechu)
9 Madhuka - + - -
(Madhuca
longifolia)
10 Vata (Ficus - - - +
benghalensis)
11 Sarja (Vateria - - - +
indica)
12 Irimeda - - - +
(Acacia
farnesiana)
13 Apamarga - - - +
(Achyranthes
aspera)
14 Nyagrodha - - + -
(Ficus
benghalensis)

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Special effects of drugs used in danthadhavana according to bhavaprakasha

SL.NO DRUGS SPECIAL EFFECTS

1 Arka (Calotropis gigantea) Bestows valour
2 Vata (Ficus benghalensis) Bestows brightness
3 Karanja (Pongamia Success
pinnata)
4 Plaksha (Ficus virens) Plenty of wealth
5 Vidari (Pueraria tuberose) Pleasant voice
6 Khadira (Acacia catechu) Good smell of the mouth
7 Bilva (Aegle marmelos) Plenty of money
8 Udumbara (Ficus Perfect speech
racemosa)
9 Amra (Mangifera indica) Health
10 Kadamba (Neolamarckia Courage and ingenuity
cadamba)
11 Campaka (Magnolia Steady mind
champaca)
12 Sirisa (Albizia lebbeck) Reputation, long life and health
13 Apamarga (Achyranthes Courage and intelligence
aspera)
14 Asana (Pterocarpus The power of correct knowledge
marsupium)
15 Dadima (Punica Beautiful countenance
granatum)
16 Kakubha (Terminalia Beautiful countenance
arjuna)
17 Kutaja (Holarrhena Beautifulcountenance
antidysenterica)
18 Jati (Jasminum Wardoff bad dreams
grandiflorum)
19 Tagara (Valeriana Wardoff bad dreams
wallichii)

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20 Mandara (Bauhinia Wardoff bad dreams

variegata)

Special effects of drugs used in danthadhavana according to yoga ratnakara

SL.NO DRUGS SPECIAL EFFECTS

1 Arka (Calotropis gigantea) Veerya ie, sukra
2 Vata (Ficus benghalensis) Agnideepti
3 Karanja (Pongamia Ensure success (over oral cavity diseases)
pinnata)
4 Plaksha (Ficus virens) Improves money flow
5 Badara (Ziziphus jujuba) Improves voice
6 Khadira (Acacia catechu) Promotes good smell
7 Bilwa (Aegle marmelos) Helps in accumulation of money
8 Udumbara (Ficus Improves voice
racemosa)
9 Amra (Mangifera indica) Promotes good health
10 Kadamba (Neolamarckia Improves memory, intelligence
cadamba)
11 Campa (Magnolia Strong, powerful speech and hearing ability
champaca)
12 Sirisa (Albizia lebbeck) Kirti (fame), wealth, long life and health
13 Apamarga (Achyranthes Courage, intelligence, ability to speak
aspera) effectively
14 Dadima (Punica granatum) Promotes beauty of the person
15 Arjuna (Terminalia arjuna) Promotes figure
16 Kutaja (Holarrhena Promotes figure
antidysenterica)
17 Jati (Jasminum Arrest bad dreams in the sleep
grandiflorum)
18 Tagara (Valeriana wallichii) Arrest bad dreams in the sleep

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Drugs contraindicated in danta dhavana

Twigs of Shleshmataka(Cordia dichotoma), Arista(Azadirachta indica),

bibhitaka(Terminalia bellerica), Dhava(Anogeissus latifolia), Dhanvana(Grewia tiliaefolia),
bilva(Aegle marmelos), Vancula(, Nirgundi(Vitex negundo), Sigru(Moringa oleifera),
Tilvaka(Symplocos racemosa), Tinduka(Diospyros tomentosa), Kovidara(Bauhinia variegate),
Sami(Prosopis cineraria), Pilu(Salvadora persica), Pippali(Piper longum), Ingudi(Terminalia
catappa), Gugullu(Commiphora mukul), Paribhadraka(Erythrina indica), Amlika(Tamarindus
indica), Mochaka(Musa paradisiaca), Salmali(Bombax ceiba) and Sana (Senna
alexandrina)should not be used as tooth brush, so also the twigs of those trees which have
sweet, sour and salt tastes, which are very dry, hollow, emitting bad smell and gummy.

DANTA DHAVANA ANARHA (Conditions contraindicated for Toothbrushing) 65

1. Ajirna- Indigestion
Do not brush the teeth immediately after an episode of acid reflux. Acid reflux
can make irreversible damage to the pearly whites of the teeth. Acid reflux, GERD and
indigestion are all similar in symptoms. So, in case of ajirna, instead of tooth brushing,
rinse the mouth with water to dilute the acid and sit an hour before brushing to allow
the saliva to rebuild the minerals on the surface of the teeth.

2. Vamathu – Vomiting
Do not brush the teeth after vomiting, because the acid in the vomit will cause
erosion of the enamel that protects the teeth, dryness, sores, redness of the mouth and
tongue, chronic sore throats etc. Erosion increases the risk of decay, causing more
cavities and sensitivity of the teeth.

3. Swasa – Dyspnoea
People who use asthma medication are at higher risk of having dental caries
and other oral health problems. Also, dental materials including dentrifices, tooth
enamel dust etc may exacerbate asthma. It is recommended that patients should breathe
regularly and slowly during dental procedures, as a quickening breath decreases oxygen
levels and increase feelings of panic.

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4. Kasa – Cough
If a person has cough and having poor oral hygiene, there will be a chance of
oral bacteria to travel from the mouth to the lungs where it can lead to a persistent
cough. Frequent coughing can quickly dry out the teeth, gums and lips. Also coughing
make basic dental cleanings and procedures more uncomfortable.

5. Jwara – Fever
High fever can disrupt tooth formation causing the discolouration and pitting
of the enamel surface which can harbour extra bacteria and affect oral health.
Regardless of the state of overall health, one should not give up on brushing when sick
and it is nice to replace toothbrushes every six weeks.

6. Ardita - Facial paralysis

Facial paralysis people cannot do brushing effectively because of limited range
of motion. It can be difficult for someone with facial palsy to keep their mouth open for
a length of time due to tight muscles in the face and neck.

7. Trshna-Thirst
The wider the mouth is opened during brushing, the more the air that rushes
in and higher the chances of the mouth drying out while brushing, which further
aggravates the thirst.

8. Asya paka - Ulcers of mouth

The excessive force when brushing teeth may damage the soft tissues of the
mouth leading to the aggravation of mouth ulcer.

9. Hrit Netra Shira karnaamayi - Diseases of Heart, Eyes, Head and Ears
Even routine dental procedures such us tooth brushing can cause bleeding in
the mouth, which then allows oral bacteria to enter the bloodstream and possibly travel
to the heart. For a patient with a heart condition this bacterium possess the potentially
dangerous risk of endocarditis, inflammation of the heart valves or tissues. So,
antibiotics are recommended prior to any dental visit, even routine cleanings.

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There is a link between infection of the eye and dental infection. Due to
their anatomical proximity, the eyes and teeth share many nerves and vascular
connections through the sinus and jaw bone. So, brushing can irritate the jaws and thus
resulting in a migraine and eye pain.
At the time of toothbrushing, the muscles in the jaw become overworked
and cause headache and ear diseases.

Effect of danta dhavana

Regular practice of Danta dhavana gives following effect.

1. Nihanti gandha vairasyam-removes the foul smell

2. Niskrushya malam jihwa dantaasyajam - removes the dirt of the tongue,

teeth and mouth

3. Ruchimadhatae-improves the taste

4. Vaisadya-cleanliness

5. Laghuta-softness of mouth

6. Soumanasya-cheerfulness of mind.

After care

According to Astanga sangraha, after cleaning the teeth, the gums are also cleaned without
hurting them, by rubbing with powder of vapya and trikatu, triphala and trijathaka mixed with
honey.

According to Surutha samhitha, teeth should be smeared with powders of vyosha and trivarga
mixed with honey, oil and saindhava: or powder of tejovathi.

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GANDUSHA

Etymological derivation of gandusha

The word 'gandusha" is derived from - गतड +गण्डे च्च dhatu means िदनेकदे श

implies gandusha is done in the part of vadana (mouth) and its meaning is – मु खपूरणम् or filling
the mouth.

Definition

• असञ्चायोमु खेपूणेगण्डूष

Gandusha dharana is filling the oral cavity with specially prepared medicine to its full capacity
without swallowing and active movements.

Types of Gandusha

Based on its effect on dosha, gandusha is classified mainly into four types. They are.

 Snaihika" or Snigdha (lubricating) -indicated in vata disorders

 Samana (mitigating)- indicated in pitta disorders

 Sodhana (purificatory) -indicated in kapha disorders

 Ropana (healing) -indicated in ulceration of mukha

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Drugs advised for daily use for gandusha

While explaining gandusha, mamsa rasa and taila are quoted for daily use Acharya Susruta and
Vagbhata mentioned the term 'sneha gandusha dharana while Charakacharya mentioned "taila
gandusha dharana in dinacharya.

Types of gandusha and rasa of drugs

Type of gandusha A.H A. S Sa. S

snaihika Madhura, amla, Madhura, amla, -----
lavana lavana
samana Thiktha, Kashaya, Thiktha, Kashaya, madhura
madhyra madhura
sodhana Thiktha, katu, amla, katu, amla, lavana katu, amla, lavana
lavana
Ropana Kashaya, thiktha Kashaya, madhura Kashaya, thiktha,
madhura

Types of gandusha and drugs used

SNAIHIKA

Sneha (oil), mamsarasa (meat soup), tilakalkodaka, tilakalka ksheera (paste of tila mixed with
water or ksheeram).

SAMANA

Decoction of any of these or combination of patola, arishta, jambu, amra, malathipallava,

utpala, madhuka,

Sithodaka (cold water), kshoudram (honey). ksheeram, ikshurasam, ghrtha, taila

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SODHANA

Decoction of Sirovirechana gana dravyam (vidangam, apamarga, vyosha, surala beejam, darvi,
brihati, sigru beejam, madhuka saram, saindhavam. tarkshyasila, two types of truti, prthvika)

Sukta (sour-whey), madya, dhanyamla, mutra (urine of animals) mixed with appropriate drugs.

ROPANA

Kashaya madhura seeta Dravya

Gandusha dravadravya

Sneha, ksheera, madhoodaka (honey-water), sukta (fermented gruel), madya, mamsa rasa
(meat soup), mutra (urine of animals) and dhanyamla are indicated.

Different types of gandusha dravyas and its indications

A wide range of gandusha dravyas are mentioned by different acharyas as both pradhana karma
and paschath karma. Different formulations are indicated as per the clinical presentation of the
disease or its various symptoms which are exhibited.

Gandusha used in local and systemic illness, different indications and the medicine used in
classics are mentioned as below

Indication Gandusha dravya

Dantaharsha Tilakalkodakam water
(Paste of tila mixed with Sarpi (ghee)
Dantachalam

Vatika mukha roga

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Oosha (Localized burning sensation) Sarpi (ghee

Daha (Generalized burning sensation)
Paka (Ulceration) Ksheeram
Aganthuja kshata (Wound by foreign body)
Visha
Ksharagni dagdam (Burns by alkali or kshara)

Daha Madhu
Trishna
Vranaropana (heals ulcer quickly)
Removes sliminess of mouth

Asyasosham (Dryness of mouth) Dhanyamla without salt

Vaktra lakhavam (Lightness of mouth) Sukhoshnodakam
Burning sensation of mouth and throat Tila, nilolpala, ghee and sugar mixed with milk
and honey

Age limitation of gandusha

Gandusha is contraindicated below the age of 5 years."

Gandusha anarha (contraindications)

Gandusha is contraindicated in following conditions

 Visha
 Moorcha
 Mada
 Sosham
 Raktapitta

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 Kupitha akshimala
 Ksheena
 Rooksha

Preparation of medicine for gandusha

The liquids mentioned for gandusha are selected according to the condition. It is mixed with
kalka (paste of drugs) which is either cooked or uncooked and made into sita (cold) or ushna
(hot).

The dravadravyas mentioned for gandusha are mixed with 1 kola matra of chooma of drugs
and filtered through cloth and are made into sita (cold) or ushna tho) according to the
condition,"

Gandusha matra (dose)

Even though the definition states that oral cavity is to be filled with medicines, acharya
vagbhata mentions three doses for doing gandusha.

1.Utama matra

Quantity filling half the oral volume

2.Madhyama matra

Quantity filling one third of oral volume

3.Avara matra

Quantity filling one fourth of oral volume

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Gandusha dharana vidhi (procedure)

• Poorva karma

The patient should be made to sit in a place devoid of wind but having ufficient sunlight and
subjected to fomentation and gentle massage over neck region, cheek, forehead and shoulder

• Pradhana karma

Then the patient is advised to hold medicine in a quantity either full or half or one third or one
fourth of oral capacity without swallowing and active movement up to their tolerance level,
with head in a slightly elevated position

• Paschath karma

Again, the patient should be given fomentation and massage which causes kapha to accumulate
in the mouth. The liquid should be retained in the mouth till it shows the signs of kapha
accumulation, exudation in nostrils and eyes or till disappearance of Kapha by the action of
drug

In this way the procedure is repeated for three, five or seven times or appearance of signs of
properly done dhoomapana

features of properly done gandusha

 Feeling of mouth filled with kapha

 Dissappearance of kapha
 Restoration of health
 Clear the impurities from heart and throat

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 Clarity of sense organs

 Lightness of head
 Mitigation of disease
 Feeling of contentment
 Cleanliness of mouth
 Lightness of mouth

Features of insufficiently done gandusha

 Appearance of lassitude
 Inability to sense proper taste
 Loss of appetite
 Excessive salivation
 Coating of dirt inside mouth
 Excessive accumulation of kapha

Features of excessively done gandusha

 Dryness of mouth
 Ulceration
 Weakness
 Loss of appetite
 Increased heart rate
 Weakness of voice
 Ringing sound in ears
 Thirst

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Contraindication for Gandusha dharana / Gandusha Anarha

 Visha
 Moorcha
 Mada
 Sosham
 Raktapitta
 Kupita akshimala
 Ksheena
 Rooksha

Benefits of Nithya Taila Gandusha Dharana

Ayurvedic classics mentiones about the benefits of taila gandusha dharana and they are

 hanubala (strength of facial bones)

 swarabala (strenght of voice)

 vadanopachayam param (good for oral health)

 rasagyaanam param (excellent perception of taste)

 uttama ruchi (increased taste for food items)

 good for kantha sosha (good in throat dryness)

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 good for preventing oshta sphutana (good for preventing dryness and cracks)

 good in preventing danta kshaya, and makes the danta with dridhamula (good for
attainingf healthy teeth)

 pain and sensitivity of the teeth dissapears "na shulyante na cha amlena
hrishyante"(good for preventing teeth sensitivity and pain)

 one can even eat the hardest food articles

Some Important Yogas of Gandusha

(1) Hot water gandusha in general Kapha disorders of mukha

(2) Gandusha with Kanji or Dhanyamla in Aruchi

(3) Daruharidra rasa Kriya or Triphala Kashiya Gandusha in Mukhapaka.

(4) Trikatu Sasharpa + Hareetaki Kalkam + Kshärajala Gandusha in Kaphaja Mukha

roga.

(5) Tila Kalka + Water gandusha in danta harsha.

(6) Ghrita or Ksheera gandusha in Pittaja mukha rogas

(7) Ksheeri Vrukshya Kashiya gandusha in bleeding gums.

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(8) Decoction of Käseesa, Lodhra, Pippali, Manashila, priyangu, Tejohwa + Honey-

Gandusha in Pyorrhoea (pus discharge from gums)

(9) Pancha pallava kashaya + ghrita + madu + Sugar Gandusha in (Gingivitis)

Upakusha.

(10) Gandusha with Irimedadi, taila or sahacharadi taila or sasharpa taila or narayana
taila or prasarani taila in gum disorders (Danta mula vyadhies).

(11) The decoction of Lodhra, mustā, jatāmānsi, rasanjan, Patranga + Honey,

gandusha in saushira (Danta mula Vyadhi).

(12) Patola, Nimba, Triphala Kashaya gandusha in gum disorders

(13) Dasha mula kashāya + Tila taila gandusha in Danta rogas.

(14) Trikatu, Sasharpa. Saindhava Lavana, gandusha in Kaphaja jihwha roga

(15) Kshara jala gandusha i Kaphaja mukha roga.

(16) Tila taila gandusha is better to do daily to preve mukharoga

(17) Yastimadhu Kashaya gandusha in Mukha paka.

(18) Kakolyad Vidārigandhādi ghrita gandusha in Pittaja mukha rogas.

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KABALA GRAHA

Kabala word meaning- a mouthful

Definition

Kabalagraha is the procedure in which the oral cavity is filled with specially prepared medicine
to the maximum capacity which allows active movements (ensuring the movement of drug
between the buccal cavity and oropharynx alternately) up to their tolerance level, with head in
slightly elevated position.

Types of Kabalagraha

Kabalagraha is of four kinds. They are

 Snehi (lubricatory)

 Prasadi (cleansing)

 Sodhi (purificatory)

 Ropana (healing)

 Snehi (lubricatory) is done with sneha which are snigdha and ushna in property and
indicated in vatika conditions.

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 Prasadi or lubricating kabala are done with drugs of sweet taste and cold in potency and
useful in paithika conditions.

 Sodhi or purificatory kabala with liquids which are pungent, sour and salt in taste, non-
unctuous and hot in potency and used in aggravation of kaphaja conditions.

 Ropana is with liquids which are astringent, bitter, sweet and pungent in taste and hot
in potency and used for healing ulcers"

Preparation of medicine

According to Acharya Sangadhara dravadravyas mentioned for Kabala are mixed with I karsha
matra of kalka of drugs and made into sita (cold) or ushna (hot) according to the condition.

Kabalagraha matra

The exact matra is not mentioned by Susruta or Ashtanga Hrdaya regarding kabala and is
mentioned like the quantity of medicine which can be moved inside the mouths easily

Acharya Vagbhata, in Ashtanga Sangraha mentioned three convenient doses of drava for
performing this procedure which is same as gandusha.

The drava matra is selected accordingly and 1 kola of kalka is added with this

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Kabalagraha vidhi

Poorva karma

The patient should be made to sit in a place devoid of wind but having sufficient sunlight and
subjected to fomentation and gentle massage over neck region, cheek, forehead and shoulder.

Pradhana karma

Then the patient is advised to hold medicine in a quantity which allows active movement
(ensuring the movement of drug between the buccal cavity and pharynx alternately) without
swallowing up to their tolerance level, with head in a slightly elevated position.

Paschath karma

Again, the patient should be given fomentation and massage which causes kapha to accumulate
in the mouth. The liquid should be retained in the mouth till it shows the signs of kapha
accumulation, exudation in nostrils and eyes or till appearance of kapha by the action of drug

In this way the procedure is repeated for three, five or seven times or till arance of signs of
properly done dhoomapana.

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Samyak lakshana, Ayoga, Athiyoga

The atiyoga, ayoga and samyak lakshana are similar to gandoosha. According to Vaghhata,
Susruta and Bhavaprakasakara preparation of medicine, types, time period, matra, anarha,
samyak, ayoga and athiyoga lakshana are same for both kabala and gandoosha and the only
difference is in the procedure.

Difference between gandusha and kabala

Gandusha Kabala graha

Procedure Procedure

. Gandusha dharana is filling the oral cavity Kabalagraha is the procedure in which the
with specially prepared medicine to its full oral cavity is filled with specially prepared
capacity/half the oral volume/one medicine to the maximum capacity which
volume/one third of oral fourth of oral allows active movements (ensuring the
volume without swallowing and active movement of drug between the buccal cavity
movement up to their tolerance level, with and oropharynx alternately) up to their
head in slightly elevated position tolerance level, with head in slightly elevated
position.

Medicine preparation
Medicine preparation
Kabala is done with kalka (paste of drug
Gandusha is done with liquid. (The
mixed with or without liquid)
medicine prepared and filtered through a
cloth)
• Dose of kalka for kabala is 1 karsha (12gm)
Dose of Choorna (powder) for Gandusha is I
kola (6gm)

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PRATISARANA

Nirukti

प्रतिसारण. —i. e.प्रति, sri + ana 1. Repelling. 2. Applying remedies to a wound.

Definition

Pratisarana is the process of application of medicines. It is mentioned in the text of Gandushadi

vidhi according to Vagbhata. Susruta, Sarangdhara and Bhavamisra It is a commonly used
procedure for treating diseases of oral cavity.

“प्रतिसारणं अङ्गुल्या घषषणम्

According to Arunadatta, it is the application of medicine with the tip of index finger

Synonyms

Pratigharshanam

Sravanam

TYPES

Types of pratisarana explained by Acharyas are as follows:

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Susrutha Vagbhata Sarangadhara

Kalka kalka kalka
rasakriya rasakriya avaleha
Choorna choorna choorna
kshoudram ------ ------

 Kalka is the form of medicine obtained by macerating the drug itself (for andra dravya)
or using water (for sushka dravya)

 Rasakriya' is the form obtained by adding honey to appropriate medicine.

 Choorna method is the application of powdered form of medicine

 Kshoudram is the application of honey.

Dose

Kolathi matra (3gm).

Time period

Duration for application of pratisarana is explained as 5 or 7 days based on disease condition

as per Dalhana,

Method of application (pratisarana vidhi)

The medicine either ground to a paste (kalka), powdered (chooma) or mixed with honey
(rasakriya) or honey alone (kshoudra) is taken with the tip of index finger and applied to the
part affected and then slowly rubbed. Acharya Susrutha, Samgadhara and Arunadatta,
mentioned the application of medicine with tip of anguli

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Indications of pratisarana

It is indicated in conditions like

 Abhishyanda

 Adhimandha

 Galasuntika

Benefits of pratisarana

In "Dhoomapanadi vidhi prakarana Bhavamista describes pratisarana as beneficial in

conditions like

 Vairayam (abnormal taste)

 Mukhadourgandhyam (bad smell)

 Mukhasesham (dryness of mouth)

 Trina (thirst)

 Anchi (anorexia)

 Dantapeeda (tooth ache)

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Samyak lakshanas of pratisarana

Dahana explains the signs of properly done pratisarana in the chapter Dhooma nasa
kavalagraba chikitsa as

 Visadatwa (cleanliness of mouth)

 Laghava (lightness of mouth)

 Khavadhu (sneezing)

 Apraseka (removes excess salivation)

 Annabhilasha (desire for food)

Pratisarana-atiyoga

Acharya Susrutha, ashtanga samgraha and bhavaprakasha contraindicated atigharshana or

application of medicine that pressure. Athigharshana results in following symptoms

 Osha (localised burningsensation)

 Daha (generalized burning sensation)

 Swayadhu (swelling)

 Kleda (sliminess)

 Trishna (excessive thirst)

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 Abhaktachanda (aversion to food)

 Vaksanga (difficulty in speaking)

 Mukha paka (ulceration of mouth)

 Klama (fatigue)

 Sosha (debility

 Vami (vomiting)

Pratisarana heenayoga

Signs of insufficiently done pratisarana as per acharyas are

 Paichilya (sliminess of mouth)

 Anannabhilasha (aversion to food)

 Gurutva (heaviness)

 Pramoha (unconsciousness)

 Vikaraanupasaya (aggravate disease)

 Jadya (lassitude)

 Kaphotklesam (excessive accumulation of kapha)

 Arasa jnanam (difficulty to perceive taste)

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JIHWANIRLEKHANAM

Tongue cleaning is an important hygienic practise which helps in the

removal of dead skin cells, bacteria, fungi and food debris from the surface of the
tongue. Brushing and rinsing alone can only remove the outer layer of bacteria while
tongue scrapers can remove majority of them than brushing alone. Acharya Charaka
explained non-sharp and curved tongue scrapers made up of gold, silver, copper, tin and
brass. As per Acharya Bhavamisra, the soft herbal stick used as toothbrush, or soft
leaves with a length of ten angula are recommended for tongue cleaning which removes
dirt, bad taste and smell.

Benefits
 Removes dirt of the tongue

 Removes bad taste and smell from mouth

 Relieves sluggishness

MUKHAPRAKSHALANAM

According to Acharya Bhavamisra, Mouthwash with cold water cures

bleeding disease, dryness and mucosal infections like pidika, nilika and vyanga.
Mouthwash with lukewarm water cleanses the mouth, mitigate kapha, vata and oiliness
and cures dryness of the mouth73.
Mouth and face are to be washed with clean water silently, without looking
at the other sides and by facing towards the direction of east or north. It should be
frequently done after the removal of the dirt deposit (plaque) in the dental crevices,
coatings of the tongue etc. Mouth and face must be washed prior to taking food,
worshipping a diety, after taking food, cutting of nails, awakening from sleep, sneezing
and travelling outside the house.

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THAMBULACHARVANAM

According to Acharya Charaka a person desirous of clarity, relish and

fragrance of the mouth should chew the fragrant fruits of jati (nutmeg), katuka (yellow
gentian), puga (betelnut), flower stalk of lavanga (cloves), kakkola (cubebs), tambula
(betel leaf), exudate of karpura (camphor) and fruits of sukshmaila (cardamom).
As per Acharya Bhavamisra, Tambula (pan chewing) is penetrating into the
tissues, improves taste, wards off sleshma(kapha), bad smell of the mouth, bestows
cleanliness and good smell of the mouth, removes the wastes/ dirt of the jaws and teeth,
cleanses the tongue, mitigates excess of salivation and cures diseases of the throat.

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ILL EFFECTS OF POOR MUKHA SWASTHYAM

Poor oral hygiene hampers the attractive personality and can create
ulceration, particularly, about the mouth i.e., on the gums, in the crevices between the
teeth, palate, tongue etc. causes bad breath and further inflammatory states of the tonsils
and throat. Leucoplakia and whitish patches due to manila infection are often seen on
the base of the mouth. Frequent mouth wash and rinsing with liquids recommended for
oral hygiene should be done for the freshness of the mouth.

Ayurveda classics described Mukharoga (diseases of the oral cavity) in a systematic way with
variations in number and sites of disease as follows

Name of book Number of mukha roga

Ashtanga hridaya 75
Susruta samhita 65
Bhavaprakasha 67
yogaratnakara 67
Sarangadhara samhita 74
videha 64
Charaka samhita 64

Acharya Charaka described 4 types of mukha roga on basis of dosha predominance as

i Vatika mukha rogas

ii. Paitika mukha rogas

iii Kaphaja mukha rogas

iv. Sannipathika mukha rogas

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Charaka also mentioned 64 types of mukha rogas based on samsthana (location).

dooshya, akrithi (shape) and nama (nomenclature). But description of all diseases is not
available. In the chapter 'Sophachikitsa' diseases like valaya, kantasalukam,
taluvidradhi, upajihwika, adhijihwika, Upakusha, dantavidradhi, galaganda and
gandamala are described.

Classification of mukha rogas based on minor parts

Sthana Ah & Sa. S MN Sa. S BP YR

(site) A.SAM
Osta 11 8 8 11 8 8
(Diseases of
lips)
Dantamoola 13 15 16 13 16 16
(Diseases of
gums)
Dantarogas 10 8 8 10 8 8
(Diseases of
teeth)
Jihwarogas 6 5 5 6 5 5
(Diseases of
the tongue)
Talurogas 8 9 9 8 9 8
(Diseases of
palate)
Galarogas 18 17 18 18
(Diseases of
throat)
Sarvasara 8 3 3 8 3 3
(Diseases of
whole oral
cavity)
Ganda roga 1 - - - - -

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Total 75 65 66 74 66 67

Mukharoga Sadharana Nidana

Aahara: Acharya Caraka has described that excessive use of madhura, amla and lavana rasa
produce various danta rogas. Acharya Kasyapa has mentioned the samanya nidanas of
mukharogas under the heading of pratisyayacikitsa. Partaking meat of matsya, maahisha and
varaha, aamamulaka, maashasupa, dadhi, ksheera, shuktha, ikshurasa and phanita.

 Matsya maamsa (Fish meat) is having madhura rasa (sweet in taste), sheetaguna (cold
in property), ushnaveerya (hot in potency), amlavipaka (sour in action) and
pittakaphavardhaka.
 Maahisha maamsa (Buffalo meat) is having madhura rasa, guruguna (heavy in
property), ushnaveerya, katuvipaka (pungent in action) and kapha, rakta, pittavardhaka.
 Varaha maamsa (Pork) is having snigdha(unctuous) and guru Guna.
 Aamamoolaka (Unripe radish) is having katu and tikta (Pungent and Bitter taste) in
rasa, tikshna (Sharp acting) and laghu (easy to digest) in guna, ushnaveerya and
katuvipaka.
 Maashasupa (Soup of Black gram) is having madhura rasa, snigdha and guru guna,
ushnaveerya, katuvipaka and kapha pitta vardhaka.
 Dadhi (Curd) is having amlarasa, guruguna, ushnaveerya, amlavipaka and kapha
pittavardhaka property.
 Ksheera (Milk) is having madhura rasa, snigdha guna, ushnaveerya, amlavipaka and
kapha vardhaka.
 Ikshurasa (Sugarcane juice) is having madura rasa, snigdha guru gunayuktha,
sheethaveerya (Cold in potency), madhuravipaka and kaphavardhaka.
 Phanita (Molasses) is having amlarasa, abhishyandakaaraka (slimy and heavy
substance that cause obstruction to srotas), seethavirya, madhuravipaka and
kaphavardhaka. All these are leading to Mukharogas.

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Vihara: Sleeping with the face down(avaaksayya), not cleaning the teeth daily
(dantadhavana dwesham), improper administration of therapies like dhoomapaana, vamana,
gandusha and siravyadhana.

Samprapti

Nidana → Aahara & Vihaara

Kapha vitiation

Mukharoga

Dantha rogas by different acharyas

SL.NO NAME AH& SU. S MN SA. S BP YR BHOJA

AS
1 Dalana + + + + + + +
2 Krimidanta + + + + + + +
3 Dantaharsha + + + + + + +
4 Dantabhanjana - + + - + + +
ka
5 Dantasarkara + + + + + + +
6 Kapalika + + + + + + +
7 Syavadanta + + + + + + +
8 Hanumoksha + + - - - + +
9 Karala + - - + + - -
10 Dantachala + - - + - - -
11 Adhidanta + - - + - - -
12 Dantabheda + - - + - - -
13 Dantavidradhi - - + - - - -

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TOTAL 11 8 8 10 8 8 8

Danthamoolagatha rogas by different acharyas

SL.NO NAME SU. S AH&AS BP MN SA. S YR

1 Sitada + + + + + +
2 Dantapuppuda + + + + + +
3 Dantavesta + - + + + +
4 Sousira + + + + + +
5 Mahasousira + + + + + +
6 Paridara + - + + - +
7 Upakusa + + + + - +
8 Vaidarbha + + + + + +
9 Vardhana + - + + + +
10 Adhimamsa + + + + + +
11 Vataja nadi + + + + + +
12 Pittaja nadi + + + + + +
13 Kaphaja nadi + + + + + +
14 Sannipataja + + + + + +
15 Salyaja nadi + + + + + +
16 Vidradhi - + + - - +
17 Karala - - - + - -
Total 15 13 16 16 13 16

Common illness of mukha caused by improper oral hygiene

DANTA SARKARA (DENTAL CALCULUS)

Due to improper cleaning of oral cavity and teeth, the vitiated vatadosha dry the
kapha and dantamala. So, the teeth appear with yellow or brown coloured precipitation and

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foul smelling. If it is not treated timely, then leads to tooth decay and diseases like loosening
of the gums, gingivitis and ultimately leads to pyorrhoea and tooth loss.

Chikitsa

1. Nidanaparivarjana- restrict madhura rasa pradhana aahara and wash the mouth after
every meal.
2. Mukhasodhana (Proper brushing and Gargling)
3. Dantamala lekhana without injuring enamel and gums (Scaling or scraping of the
yellow hard pigment) (Scaling means a common non-surgical treatment for removal of
infected deposits from the tooth surface.)

KRIMIDANTA (DENTAL CARIES)

According to Susruta, due to vitiation of vata dosha the affected teeth became
black in colour, creates a small hole and then the root became weak and mobile. Severe pain
(Toothache) at any time without any cause is known as ‘Krimidanta’.

According to Vagbhata, when dantamulagata vata become vitiated and

unskilled attempt(picking) to remove the impacked food causes injury to dantamoola and then
bacteria will grow with food, drinks and infected to pulp cavity. This causes severe irregular
pain, dantakshaya (Tooth decay) etc.

SYAVA DANTA (STAIN TEETH)

The oral cavity is subjected to many types of exogenous and endogenous

substances which can stain teeth and since the oral flora in many cases contains chromogenic
microorganisms-stained deposits are common on the teeth.

UPAKUSHA (GINGIVITIS)

Upakusha is a pitta and rakta pradhana roga affecting gums. According to Susrutha, it is
characterised by burning sensation and ulceration of gums, because of these the teeth becomes
shaky and when stroked it produces profuse bleeding with pain. After bleeding it swells up

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again leading to halitosis (foul smell of mouth). Along with these symptoms, Vagbhata includes
kandu or itching.

The classical treatment modality of Upakusha mentioned by Acharya Susruta includes

sodhana therapies (purification methods) pratisarana, kavala and nasyam. Sodhana therapies
like vamana, virechana, nasya and raktamoksha are done initially. Susruta mentioned
raktamoksha with kaka udumbarika (Ficus hispida) and gojihwa (Elephantopus scaber).
Pratisarana is advised with trikatu and saindhava lavana along with honey. After that kavala
with warm decoction of pippali, swetasarshapa, sunti and fruit of nichulaphala is advised,
Ghritam cooked with madhura rasa predominant drugs are advised for kavala and nasya."

Acharya Vagbhata described a different treatment modality. Initially gums are fomented by
holding hot water in the mouth. It is followed by lekhana (scrapping) with mandalagrasastra or
leaves of saka patra, for many times. Pratisarana with laksha, priyangu, patanga, saindhava
lavana, gairika, kushta, sunti, maricha, yashtimadhu, rasanjana with ghrtamanda (scum of ghee)
and honey. After pratisarana kavala is mentioned with luke warm ghrtamanda or taila. Ghritam
cooked with madhura rasa predominant drugs are advised for kavala and nasya.

SHEETADA

Sheetada is a disease described elaborately in Ayurveda as a type of Dantamoolagataroga

(periodontal disease). The symptomatology of Sheetada can be considered as general marginal
and papillary gingivitis, which may progress into periodontitis if not treated properly. Sheetada
occurs due to vitiated Kapha and Rakta. The clinical features of the disease are Raktasrava
(bleeding gums), Krishnata (discoloration of gums), Prakledata (moistness), Mriduta
(spongyness), Shotha (gingival swelling), Mukhadaurgandhya (halitosis) at the initial stage. In
a later stage, Paka (suppuration), Dantamamsa Shiryamanata (gum recession) and Chalata
(tooth mobility) may be seen. For the management of this disease systemic therapy, such as
Nasya (insufflation), and local therapies such as Raktavisravana (bloodletting), Pratisarana
(local application), Gandoosha (mouthwash), Kavala (gargle), and Pralepana (paste) are
advocated

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DRUG REVIEW

ARJUNA

Scientific name: Terminalia arjuna

Family name: combretaceae

Vernacular names

Sanskrit: arjuna

English: arjun tree

Malayalam: neermaruth

In India Arjuna is one of most religious and sacred trees. Leaves and flowers of this tree are
used for Lord Vishnu and Ganesh pooja on the religious occasions. From ancient times this
herb is used in Ayurvedic preparation for its versatile medicinal properties.

Varieties

There are two types with similar effects. Arjuna - Terminalia arjuna – white variety Kakubha -
Terminalia alata (Terminalia tomentosa) black variety. Terminalia arjuna being taken as the
source of Arjuna. But some take T. panniculata & even T. tomentosa as Arjuna. Even Sterculia
urens is considered as Arjuna in Rajasthan & in parts of Pakistan.

Sanskrit synonyms

Dhavala - the external layer of bark is white in colour

Indradru - Tree is a very potent medicine
Nadisarja - Usually found in the river banks
Kakubha - A large tree covers large area
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Partha, Veeravruksha - A potent tee

svetavaha - Bark is white in colour
Sarpana - Large tree with spreading branches
Madhugandiprasoonaka - Flowers are sweet scented
Devasala - Tree with strong action
Hrudrogavairi - Very useful for cardiac problem
Svasaneshvara - Relieves swasa
Veeravriksha - A potent tree

Classical categorization

Charaka- Kashaya Skandha - astringent tasting group of herbs

Susruta-Nyagrodhadi, Salasaradi
Udarda prashamana - group of herbs that are used in allergic skin conditions and ring worm
Infestation
Vagbhata-Viratarvadi, Salasaradi
Bhava. Prakasha Nigantu -Haritaki kula

Medicinal properties

Terminalia arjuna medicinal properties

Rasa (taste) - Kashaya (astringent)

Guna (qualities) - Rooksha (dryness), Laghu (lightness)
Vipaka-Katu - Undergoes pungent taste conversion after digestion.
veerya Sheeta - cold potency
Prabhava special effect - Hridya - cardiac tonic

Effect on Tridosha - Balances Kapha Pitta Dosha

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Karma - Hridya, vranahara, Bhagna sandhanakara, Raktapittahara

Pharmacological action

Cardiotonic
Antidysenteric
Anti-Hypertensive
Diuretic

Part used - bark

Though stem bark is the most used part in traditional practices, fresh leaves as well as fruits
are also used for treatment.

Dosage
Powder 3-6 g; water decoction 50-100 ml, in divided dose per day. Kshira paka (Decoction
with milk) - 20-30 ml

Benefits

Terminalia arjuna is a famous Ayurvedic herb for heart care. It is also used for the treatment of
aconitum poisoning. It is a good source of calcium. Acharya Chakrapanidutta emphasized its
utility in healing fractures in 10th century AD itself.

Terminalia arjuna benefits:

 Because of its Kashaya rasa - astringent taste, it acts as Stambhana, useful in bleeding
disorders, it heals fractures and wounds quickly.

 Because of its astringent and styptic properties, it is also used in pus in urine, UTI and
dysentery.

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 PittaKapha Vrana - useful to relieve ulcers and wounds due to Pitta and Kapha
imbalance

 Medohara - reduces fat and cholesterol levels

 Mehahara - useful in urinary tract disorders and diabetes

 Hrudroga - useful in cardiac disorder

 Kshata - Useful in chest injuries

 Kshayahara - Useful in chronic respiratory disorders, tuberculosis

 Shramahara - Relieves tiredness, fatigue

 Trushnahara - Relieves thirst

 Asrajit - Useful in bleeding disorders

Major chemical constituents

Terminalia arjuna- Arachidic stearate, cerasidin, cerasidin, Arjunic Acid, tannins, Arjunone,
Arjunetin, Arjunglucosisdes, I & II; Arjunoside I, II&IV; Arjunolic acid & etc.

Bark: calcium and magnesium salts, flavonoids.

Terminalia alata- Gum, Arjunic, & Arjunolic acids, Arjunetin, Betulinic and ellagic acid,
tannins etc. (Reference: Illustrated Dravyaguna Vijnana, Vol. II, by Dr JLN Shastry)

Systemic Action (Sthanika Karma)

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 External-Astringent in taste. Has Styptic action, promote wound healing. Powder or

juice can be applied on wounds to prevent bleeding. Bark paste is indicated in fracture.

 Digestive System - Indicated in bloody diarrhea, and in Hemorrhoid's

 Circulatory System - Healthiest medication for the heart. strengthen the cardiac
muscles. elevate blood pressure and constrict tiny blood arteries. Stimulates the heart
and circulatory system and lessens swelling brought on by circulation problems.

 Respiratory System - Indicated in cough due to emaciation, reduces thirst. Its bark
powder is triturated with Vasa juice and can be administered along with honey and milk
is good to prevent Kshayaja kasa.

 Excretory System - Reduce urine production indicated in diabetes, burning micturition

and pus in urine.

 Reproductive System - Act as sukra sthambaka. Indicated in Menorrhagia, and in

Leukorrhea. decoction prepared out of its bark and sandal wood is indicated in
sukrameha.

Acharaya Charaka has placed Arjuna in Udardaprashmana Mahakashya. Arjuna used

externally as pralepa etc. and internally as Kasaya. It is used as an ingredient in many
formulations for various ailments which are listed below.

Formulations of Terminalia arjuna (Roxb.) Wight & Arn. in Ayurvedic Classics Charaka
Samhita

Formulation Indications Reference

Pralepa Bahirparimarjana Ch.Su.3/5
Udardaprashmana
Kashaya Ch.Su.4/43
mahakashya
- Dantapawana Ch.Su.5/73
Sara asava - Ch.Su.25/49
Varshya yoga Vajikarana Karma Ch.Chi.2-3/4
Chandanadi Taila Jwara Ch.Chi.3/258
Kiratiktadi Churna Raktapitta Ch. Chi 4/75

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Kaphaja Pramehahara Kaphaja Prameha Ch.Chi.6/27

Trikantkadi Sneha Prameha Ch.Chi. 6/38
Pittaja Pramehahara Pittaja Prameha Ch. Chi 6/39
Kwatha Kushta Ch.Chi.7/129
Swarasa/kwatha Malstambhana Ch.Chi.8/129
Kwatha Raktarsha Ch.Chi.14/214
Pushpa Vishara Ch.Chi.23/100
Kwatha Keeta LutaVishnashana Ch.Chi.23/204
- Vranpracchalana Ch.Chi.25/95
Churna Vrana Ch.Chi.25/113
Mahaneela Taila Palityaroga Ch. Chi 26/272
Udumbaradileha Kaphaja Hridayaroga Ch.Chi.26/98
Vasti Kashaya Skandha Ch.Vi.8/144

Sushruta Samhita: From surgery-based treatise Sushruta Samhita, Arjuna is first indicated as a
Raktastambhana dravya. Arjuna has been used as ingredient in much yoga in Sushruta Samhita
which is as follows.

Formulation Indications Reference

Rakta stambhana Su.Su.14/36
Veertarvadi Gana Su.su.38/10
Salsaradi Gana - Su. Su38/12
Nyagrodadhi Gana Kustha, Hridya, Aruchi Su.Su.38/48
Vatashamniya Varga - Su.Su.40/7
Lepa Tvaka sawrna Su.Chi.1/98
Varnaropaka Taila Vrana Ropan Su.Chi.2/65
- Bhagna rakshartha Su.Chi.3/6
Sneha Paittika Kushta Su.Chi.9/7
Kwatha Shukra Prameha Su.Chi.11/8
Yavagu Prameha Su.Chi.11/10
Kwatha Yonishula Su.Chi.15/24
Lepa Paittik Granthi Su.Chi.18/10

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Ashtanga Samgraha
Vriddha vagabhata gives first indication of Arjuna for the purpose of Danta Dhavana. Other
important yogas of Arjuna in Ashtanga Samgraha are listed below.

Formulation Indications Reference

- Danta Dhavana A.S.Su.3/13
Udardaprashmana
- A.S. Su.15/42
Mahakashya
Vasanadi Gana - A.S. Su.16/ 13
Veeratarvadi Gana - A.S.Su.16/18
Nyogradhadi Gana - A.S. Su16/35.
Phanta - A.S.Chi. 3/46
Yusha, supya - A.S.Chi. 7/101
Kwatha - A.S.Chi. 8/33
Kwatha Pittaja prameha A.S. Chi14/6
Kwatha Sukrameha A.S. Chi14/7
Trikantakadi Sneha Sarva prameha A.S.Chi.14/12
Dasmularistha - A.S.Chi.14/16
Yograja Rasayana - A.S. Chi21/14.
Pralepa - A.S.Chi.21/3
Lepa, Mardan, Sheka - A.S.Chi.23/32
Ghrita Balaroga A.S.Ut.2/58
Churna Mukhapaka A.S.Ut.6/32.
Kwatha Balatisara A.S.Ut.6/40
Kwatha - A.S.Ut.14/11
Varti Anjanartha A.S.Ut.14/36
Kashaya - A.S. Ut 26/23
Pralepa Kesha ranjana A.S.Ut.28/39
Kusha - A.S.Ut.32/23
Pralepa Arbuda A.S.Ut.35/15
Pralepa Vyanga A.S.Ut.37/24
Pralepa Paittika Updansha A.S.Ut.39/11
- Pushayanuga Churna A.S.Ut.39/61
- Yoni Shodhana A.S. Ut 39/70.
Pralepa - A.S.Ut.43/34
Kalka churna Keeta luta vrana A.S.Ut.44/58
Pan-Nasya- - A.S.Ut.45/3
Pan-Nasya- Lutavisha A.S. Ut 45/6
Kwatha Mushaka Vishahara A.S.Ut.46/31
Mahasugandhi Agada A.S.Ut.47/40
Churna Visha A.S.Ut.48/12

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Chakradutta: Acharya Chakrapani has used Arjuna in many formulations to treat various
disorders which are listed below.

Formulation Indications Advertence

Kakubhadi Kseera Yakshma, Kasa C.D.10/11
Arjunadi Kshira Hridya roga C.D.31/8
Arjuna Churna Jirna jwara, Raktapitta C.D.31/9
Godhumaparthaja churna Hridya roga C.D.31/13
Godhumakakubha avleha Hridya roga C.D.31/14
Arjuna Ghrita Sarva Hridaya Roga C.D.31/32
Kwatha Kaphaja Pramehahara C.D.35/11
Kashaya Pittaja Pramehahara C.D.35/15
Asthisanharadi Churna Bhagna C.D.49/10
Laksha guggulu Bhagna C.D.49/14-15
Lepa Vyangahara C.D.55/44

Sharangdhar Samhita: Acharya Sharangdhara has used Arjuna in many formulations to treat
various disorders which are listed below.

Formulation Indications Advertence

Nyagrodhadi kwatha Yoniroga Sha.Sa.Ma.2/115
Amaradi Hima Rakttapitta Sha.Sa.Ma.4/2.
Nilikadya Taila Palitya Sha.Sa.Ma.9/158
Devdarvadhyarishtha Prameha Sha.Sa. Ma10/54.

Vyanghara Lepa Vyanga Sha.Sa.Ut.11/12

From the above findings almost all ayurvedic classics has mentioned arjuna and its uses
especially for doing dantadhavana. Furthermore, since it has kapha and pithahara properties it
can be used extensively in preventing and curing mukha rogas since mukharoga common dosha
kopa is kapha raktha.

Experimental Studies

 Antioxidant and Cardioprotective effect

 Effects on cardiac hemodynamic, coronary flow and blood pressure
 Hypolipidemic and antiatherogenic activity
 Antimicrobial and cytotoxicity study

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Studies shows arjuna is relatively safe and has antimicrobial cardio protective
hypolipidemic and antiatherogenic properties.

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CONCLUSION

Oral hygiene is the practise of keeping one’s oral cavity clean and free of diseases and
other problems by regular brushing of the teeth and other good habits. Oral diseases can affect
overall health of an individual altering his quality of life. Knowledge and awareness about
maintaining good oral hygiene is an integral part of preventing oral diseases.

The rise in global burden of oral diseases and increase in incidence of diseases has
created a demand for alternative cost effective safe oral hygiene solutions replacing the
methods in use. Despite many chemical agents are available in different form for maintain oral
hygiene they can alter the oral microbiome in the mouth and thus alter the homeostasis and
bring unwanted side effects in the form of other infections and diseases.

Ayurveda has postulated different effective ways to maintain oral health through its
preventive principles. These are scattered throughout classics and especially in Swasthavritta
dinacharya procedures. This project study aims to enumerate these procedures in order to have
a clear picture regarding ayurveda preventive dentistry.

Objectives of the study was to have a clear understanding of oral hygiene practises in
ayurveda. Special reference was given to terminalia arjuna which is an important drug
mentioned by all classics which can be made use of in oral hygiene.

 Improper oral hygiene leads to oral diseases

 Life style ill habits also leads to oral problems
 There is lot of chemical agents and mechanical methods of maintain oral
hygiene and they are having advantages and disadvantages.
 Ayurveda preventive principles mentions lot of oral hygiene improving
techniques

Recommendations
 Study should be conducted on population in order to have clearer picture
 Need for having a cost effective and safe alternatives of modern chemical
hygiene agent can be found from ayurvedic principles through further research
works
 Awareness can be given to the public about oral health and hygiene utilizing
govt. machineries and through social media

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