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Dentistry in Ayurveda: Part Two. Dr. R. D. Das Ms. Shreya G. Bala Prof. & Head,Dept. Of Prosthodontics Intern Yerala Medical Trust’s Dental College,Kharghar, Navi Mumbai Abstract: This article, the second in the series titled Dentistry in Ayurveda, describes in brief the various therapies and medicines used in Ayurveda. Further, an attempt has been made to correlate dental diseases in Ayurveda with the modern-day classification and management. Ayurveda brings cures……… Ayurveda, does not just recognizes and classifies the diseases of the oral cavity but also gives specific treatment for the same. These Therapeutic measures are of a wide range including oral medications to surgical techniques. Mukha rogas (diseases of the face and oral cavity) These are classified as follows: I. Osta roga (diseases of lips) II. Danta moola roga (diseases of gums) III. Danta roga (diseases of teeth) IV. Jihwa roga (diseases of tongue) V. Talu roga (diseases of palate) VI. Gala roga (diseases of throat) VII. Mukha dhi ( sarvaj ) VIII. Ganda roga . Osta roga 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Vataj osta roga Pittaja osta roga Kaphajaosta prakopa Sannipathajaosta prakopa Rakthaja osta prakopa Mamsaja osta prakopa Medoja osta prakopa Kshathaja osta prakopa Khandausta (harelip) Grandhi (cyst) Jalaarbuda (mucocele) Gandalaji (cellulitis) Danta moola roga: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. SAMVRUTADANTA (HYPERTROPHY OF GUMS) VIVRUTA DANTA (ATROPHY OF GUMS) DANTAVAIDARBHA(INJURY TO GUMS) ADHIMAMSA (PERICORONITIS) DANTAVESTHA(CHRONICSUPPURATIVE GINGIVITIS) UPAKUSHA (RECURRENT ACUTE GINGIVITIS) SHEETADA (CHRONIC RECESSIVE GINGIVITIS) SOUSHIRA(SUPPURATIVE PERIODONTITIS) MAHA SOUSHIRA (NECROTISING GINGIVO-STOMATISIS) PARIDARA (ATROPHIC GINGIVITIS) DANTANADIVRANA (ALVEOLAR ABSCESS WITH SINUS) DANTA PUPPUTAKA (PERIODONTAL ABSCESS) DANTA MAMSA ARBUDA (TUMOR OF GUMS) DANTAMAMSARUK (BLEEDING GUMS) III. Dantha rogas (diseases of the teeth) IV. Jihwa gatha rogas (diseases of the tongue) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 1. Vataja jihwa kantaka Krimi dantha (dental caries) Dantha harsha (hypersensitivity) Bhanjaka Dantha shaykara (calculus) Dantha kapalika Shyavadantha (pigmentation) Hanumoksha (mandibular dislocation) Danthavidradi Karala Chaladantha Adidanth (supernumerary tooth) 2. Pittaja jihwa kantaka 3. Kaphaja jihwa kantaka 4. Alasa 5. Upajihwaka 6. Adhijihwaka Treatment for some of these dental diseases….. DISEASE MANAGEMENT of some of the diseases related to the teeth HYPERTROPHY OF GUMS ( SAMVRUTA DANTA ) Massage the inflamed gums with: 1) sesame oil + triphala + alum + kshara (alkali) + khadira ( acacia catechu) 2) Gugguli ( commiphora mukul) ATROPHY OF GUMS (VIRUTA DANTA ) Smear the gums with a paste of sesame oil + atmagupta ( mucuna pruriens ) or bala ( sida rhombifolia) or kakoli ( roscea procera) [ vitalising and bulk promoting group of drugs] PERICORONITIS OF WISDOM TEETH: Dosha involved: kapha dosha 1) Excision of fleshy mass of tissue. 2) Powder of: patha ( cissampelos pareira), vacha ( achorus calamus), yavakshara (alkali) 3)Decoction of pippali ( piper longum) + honey. CHRONIC SUPPURATIVE GINGIVITIS ( DANTA VESHTA) Dosha involved: pitta 1) Nasya ( nasal medication) 2) Rubbing with cold potency drugs: paste of- lodhra + raktachandana + yasti + laksha + honey 3) Gandoosha: decoction of nyagrodha , udumbara and plaksha + ghee. RECURRENT ACUTE SUPPURATIVE GINGIVITIS ( UPAKUSHA) Dosha involved: pitta dosha. 1) Blood letting by incision with a sharp surgical instrument. 2) Pratisarana ( rubbing ) with a paste of trikatu( dry ginger, pepper and long pepper) 3) Panchalavana ( five types of salts from different sources) and honey. 4) Gargling with decoction prepared of priyangu, laksha, gairika, supernatent layer of ghee and honey. CHRONIC SUPPURATIVE RECESSIVE GINGIVITIS ( SHEETADA) Dosha involved: kapha and pitta. 1) Blood letting done by rubbing the affected gum with rough leaves of teak 2) Kavala (gargle) with decoction of ginger , mustard and triphala. 3) Paste prepared from musta, arjuna, triphala and honey is used as lepa ( local application) 4) Nasya with oil medicated with yasti, padma and triphala. 1) LEKHANA: (scrapping of tissue) to remove the vitiated blood. 2) LEPA : (ointment prepared from lodhra ( symplocos racemosa) musta and honey applied after lekhana. 3) GARGLING with decoction of aswatta, udumbara, plaksha: for healing SUPPURATIVE PERIODONTITIS (SOUSHIRA) DOSHA INVOLVED: PITTA AND KAPHA. CHRONIC ATROPHIC GINGIVITIS ( PARIDARA) DOSHA INVOLVED: ALL THREE 1) Affected part is rubbed with leaves of kakodumbara and vitiated blood is let out. 2) mixture of rocksalt, dry ginger, pepper, long pepper, and honey ALVEOLAR ABSCESS WITH SINUS ( DANTA NADIVRANA) all doshas are involved 1) If sinus is deep: affected tooth is removed after incising the surrounding tissues. And area is cauterized by application of heat. 2) If direction of the sinus is tortuous and multiple, poorana(filling) is done with mixture of beewax and wheat flour 3) Decoction prepared of jati + madana+ gokshura+ khadira is used as a wash. PERIODONTAL ABSCESS ( DANTA PUPPUTAKA) Dosha involved is kapha. 1) RAKTA MOKSHA: blood letting, rub the affected part with salt or kshara( alkali) 2) Powder: yasti+ sunthi+ rock salt. ALVEOLAR ABSCESS ( DANTA VIDRADHI) All the three dosha TUMOURS OF THE GINGIVA ( DANTA MAMSAARBUDA): Involves all three dosha BLEEDING GUMS ( DANTA MAMSAASRUK) TARTAR ( DANTA SARKARA ) Three stages: 1) local application: powders of: kustha+ vrishchikali+ meshashringi+ yavakshara 2) Oral medication: decoction : of the varunadi gana . guggulu+ decoction of punarnava, devadaru, sunthi, haritaki. 3) Surgical procedures: after it ripens it Is drained by incising. To attain a ripe state powders of horse gram drumstick , plumbago rosea and a red variety of rice is mixed with honey and applied Incurable if swelling is hard as stone. Paste made from: haridra + lodhra + patanga mana shila 9 mineral origin) and haritala ( purified arseenic) + honey. Decoction of: patola + nimba + triphala + dry grapes + mushtha + kutaja. LOCAL HAEMOSTATIC: 1) paste : khadira + alum + dhatakipushpa + seeds of amra + karanja + arjuna + dadima + nyagrodha + nagakesara + triphala + chandana + manjistha. ORAL MEDICATION : decoction of patola + nimba + chandana + shatavari + padmaka. 1) SCRAPE AWAY 2) A mixture of lac + honey is massaged over it. 3) Decoction of yasti + tila + trivrit for gargling TOOTH ACHE ( DANTA SHOOLA) HYPERSENSITIVITY TO COLD. ( SHEETA DANTA ) Eroded enamel- vitiation of vata dosha. 1) Gandoosha: with drugs of vataprashamana gana and vedanasthapana gana. 2) Paste of : vilwa root + tila + eranda + prepared in rice gruel. 3) Paste of: guduchi leaves + triphala. 4) Latex of arka Extraction..if everything else fails 1) TOOTH POWDER : musta + rock salt + dadima + triphala + sunthi + anjana . 2) DECOCTION of bark of four Ficus species + ghee is used as nasya. EROSION OF ENAMEL ( DANTA HARSHA) 1) KAVALA : lukewarm ghee, sesame oil and decoction of bhadradarvadi gana 2) Shirovasti with oil prepared with vatahara drug is indicated. 3) Brimhana foods ( bulk promoting ): mutton soup, milk , cream, ghee DENTAL CARIES CAUSED BY WORMS (KRIMIDANTA) 1) Paste prepared of vidanga, vacha, nimba, sarshapa, yavani, nirgundi, apamarga and honey. 2) Decoction of brihati, eranda , kantakari + sesame oil is used for kavala. Extraction if all treatment fails.gargling with mixture of sesame oil ghee and powder of yasti and honey The surgical way out…… Several surgical procedures are suggested in our classical texts for treatment of various dantaroga’s or dental diseases. These are generally the last measure when all the therapeutic measures fail and the disease is likely to spread to adjacent areas. 1) DANTODHARANAM- EXTRACTION OF TOOTH. This is indicated in the following conditions: a) Danta nadivrana: Alveolar abscess with sinus likely to spread upto the jaws. b) Adhi danta: Supernumerary teeth and if this condition is painful and deters the normal functioning of the oral cavity. c) Danta shoola: in severe tooth ache not palliable by therapeutic procedures. The process of extraction can be broadly categorized into three namely a) Poorva karma (pre-operative procedures) b) Pradhana karma (operative procedures) c) Paschat karma (post-operative procedures) POORVA KARMA (pre-operative procedures): The oral cavity is cleaned well by gargling (kabvala) with decoction prepared of bark of four Ficus species. Nasal medication is done t remove the morbid dosha in the cranium. PRADHANA KARMA (operative procedures): The patient should be made to sit facing the light source. The head should be firmly placed between the knees of the danta vaidya. The affected tooth is head firmly with a yantra like sandaamsha yantra, mandalaagra yantra, sharapunkha yantra, dantashankuh shastra. The teeth of the upper jaw should be extracted with a jerky downward movement followed by a outward movement. The tooth of the lower jaw should be extracted by a jerky upward movement followed by a outward movement. These are to be followed in a meticulous and brisk manner to cause less pain and minimal bleeding. PASCHAT KARMA OR (Post -Operative Procedures) : After extraction, the gum should be cleaned well with medicated oils that relieve pain (Vedanasthapana) and promotes healing (ropana). If bleeding persists, the area should be cauterized using kahara (alkali) or by agnikarma (branding), Gandoosh with a decoction prepared of jati, mandanapala (Randia dumetorum), gokshura, (Tribulus terrestries) and khadira (Acacia catechu) is beneficial, Gargling (kavala) with yasti (Glycyrrhiza glabra) is also beneficial. COMPLICATIONS : Severe pain, bleeding, facial paralysis, weakness of the sense organ such as eye and ear are the complications arising if the extraction is done in a haphazard manner and also when pre-operative procedures are overlooked. Complications are more likely when extracting the teeth of upper jaw. CONTRAINDICATION : Tooth extraction is contraindicated in the following conditions. * Weak and debilitated individuals. * Diseased (Chronic systemic disorders). * During pregnancy and old age. * Individuals suffering from Vata disorders and bleeding disorders. * Mentally ill. SURGICAL PROCEDURES IN DANTAROGA : 1. DANTAMAMSA CHEDHANA-GINGIVECTOMY : Removal of a portion of the gum is termed as Dantamamsa chedana. It is indicated in conditions such as – a) Samvruta danta – teeth enclosed by hypertrophic gums. b) Soushira and Mahasoushira (Necrosis of the gums). c) Severe injury to the gums which are irreparable i.e. in conditions such as Danta vaidarbha. Gingivectomy is done by using a sharp surgical instrument such as Mandalaagra. 2. BHEDHANA- INCISION : This procedure is done in conditions such as dental abscess. The abscess is incised only when it has attained the state of paaka (ripe). 3. LEKHANA : SCRAPING : Scraping of the gum is done in conditions such as Upakusha (recurrent acute suppurative gingivitis) and Soushira (suppurative periodontitis). Generally it is done with medicated powders or surgical instruments. Rough surfaces of specific leaves are also used by Danta Vaidyas. 4. AGNI AND KSHARMA – CAUTERIZATION AND BRANDING : Branding locally by a hot probe is a very effective method of controlling bleeding particularly after extraction of tooth. Application of Ksharas i.e. alkaline salts such as Yavakshara, Kshara prepared from stems of lotus etc., is also useful in controlling bleeding. Cauterization is carried out by two methods and is as follows – a) Application of hot iron rods or probes. b) Use of alkalis (kshara) This procedure is indicated in the following conditions – a) Danta nadivrana or sinus tracts. b) Danta vidradhi or alveolar abscess. c) Danta vaidarba or gum injury or as a sequel to gingivectomy. 5. RAKTA MOKSHA – BLOOD LETTING : The vitiated blood in the gums and root are responsible for disease manifestation. Hence blood letting using surgical instruments or by the application of leeches is indicated. It is also done using rough surface of the leaves of teak (Tectona grandis). It is indicated in disease of gums such as Danta veshta (suppurative gingivitis), upakusha (recurrent suppurative gingivitis), soushira (necrotizing gingivitis) etc. In conclusion, Ayurveda has a vast scope in dental field. More people and health professionals in technologically advanced countries are taking an increased interest in recognizing the efficacy of these alternative medicine and health care procedures. But unfortunately we Indians have forgotten our rich heritage with loads of knowledge in dentistry. Ayurvedic medical texts have not just indicate the herbs that could halt the oral diseases and trigger the natural remineralization of decayed tooth, but also documented the oldest history of implants. Ayurveda aims to integrate and balance the body mind and soul. It achieves a state of total wellness, because of its two basic objectives 1) to maintain the health of those who are well and are not suffering from any disease condition. This mainly is achieved through regulating ones diet and nutrition , exercises, hygiene and lifestyle. 2) cure the diseases of those who are sick and follow up after cure to prevent relapse of diseases. The terms oral health and general health should not be interpreted as separate entities. Oral health is integral to general health , it is said if eyes are the windows to the soul, then mouth is the doorway to health. Conventional dentist looks at the mouth in isolation, but ayurveda considers the intricate relationship between teeth gums and rest of the human body. Rather than dealing with dental concerns as they pop up, ayurveda is designed to avert common dental problems. Contemporary dental science focuses on symptomatology of the disease, treatment methods used in it are effective but chances of toxicity exists, which may weaken the body. Ayurveda tries to bring about the balance in which the body’s natural defense will be strong and can easily defend against diseases . Ayurveda is not a substitute for contemporary dentistry but can be used in conjunction with it. This amalgamation of the two streams of treatment will work together for overall benefit of the patient, recognizing the fact that mouth impacts the overall health of a person. References: 1. http://www.ijdr.in/article.asp?issn=09709290;year=2008;volume=19;issue=1;spage=52;epage=61;aulast=Amruthesh 2. K. M. Shyam Sundar, Dentistry in Traditional Medicine.