A clinical study on Krimidanta with reference to dental caries and its management with Jatipatradi Gutika and Yavanadi Churna

Introduction

Teeth are very precious organs of the body, governing lot of functions like chewing, speech control, giving shape to the mouth and the most important of all is to maintain the beauty of the face; once they are destroyed, they cannot regrow.[1] Eight Danta Rogas are described by Acharya Sushruta; of them, Krimidanta is the one which gradually results in tooth loss, if not treated in time.

Krimidanta is characterized by black discoloration, cavity formation, swelling, pus and blood oozing and severe pain.[2] It occurs due to vitiation of Vata followed by Pitta and Kapha Dosha.

Dental caries often leads to fatal infection and may lead to death, if the patients do not take proper treatment.[3] Oral infections in patients with rheumatic or congenital heart diseases are particularly dangerous, as they can lead to the risk of infective endocarditis.[4]

Knutson's technique is widely recommended for topical application of sodium fluoride to the teeth. The effectiveness of topical fluoride administration is questioned.[5] An operative procedure such as filling and R.C.T. techniques have their own limitations. As per the World Health Organization (WHO) technical report 1995, 19 billion individuals per year are affected by dental caries; thus, this disease poses a challenge to the dentists. All these facts leave a scope to search a better remedy to the problem.

In Ayurvedic texts, a good number of medicaments are explained for strengthening the teeth and gums. These remedies are made from various plants and applied to the gums and tooth in the form of powders, oils, etc. In addition to this, bloodletting is also described in classics. In the management of Krimidanta, the drugs having Krimighna (antimicrobial), Vranaghna and Ushna Veerya are to be used which can relieve the toothache and Krimi. In the present study, the trial drugs used were Jatipatradi Gutika for Pratisarana and Yavanadi Churna (Bhaishajya Ratnavali 61/99, 30/11)[6] for oral administration.

Materials and Methods

Assessment criteria

An assessment was made on the basis of change in clinical features before and after treatment and scoring was given to each symptom with scores ranging from 0 to 3.

The details of the drugs and their administration and duration are given in Table 1.

Table 1

Drug and duration

Observations and Results

The maximum number of the patients, i.e., 32.43% reported in the age group of 41–50 years. Majority of the patients (64.86%) were females. Also, 51.36% of the patients were house wives, and majority of the patients (45.95%) belonged to middle class. 100% patients were having complaint of Chidrata, and Krishnata was present in 97.30% patients. Dantashoola was present in 94.59% patients and 89.19% patients were reported to have Dantaharsha. Daurgandhya was reported in 70.27% patients and Aniyamit Ruja was found in 54.05% patients. Three-fourths of the patients, i.e., 75.68% were using brush to maintain oral hygiene and the remaining patients were using finger for oral hygiene; more than three-fourths of the patients were using horizontal method while 18.92% patients were using vertical method for tooth brushing. Also, 65.57% patients were using tooth paste as the cleaning material and 24.32% were using tooth powder, and only 8.11% patients were using Datun. It was also observed that 70.27% of patients were vegetarians, 43.24% patients were of Vata Pitta Prakriti, 75.68% of patients were having Madhyama Samhanana and 51.35% patients were having Samagni, followed by 29.73% patients having mandagni, 10.81% having Tikshnagni and 8.11% were having Vishamagni. All the patients (100%) were having carious teeth.

In Group A, out of 13 patients, none was cured, 07.69% (one patient) showed marked improvement, 61.54% (eight patients) showed moderate improvement, and 30.77% (four patients) showed mild improvement in signs and symptoms [Figure 1]. The therapy was statistically highly significant in Dantashoola, Dantaharsha, Aniyamit Ruja and Daurgandhya. Clinically marked improvement in Srava and moderate improvement in Shotha and Paka were obtained [Table 2].

Figure 1

Overall effect of therapies

Table 2

Effect on signs and symptoms (Group A)

In Group B, out of 11 patients, none was cured and showed marked improvement [Figure 1]. Only 9.09% (1 patient) showed moderate improvement and 90.91% (10 patients) showed mild improvement. Statistically highly significant relief was obtained in the symptoms Dantashoola, Daurgandhya and Dantaharsha, and significant relief was obtained in Aniyamit Ruja [Table 3].

Table 3

Effect on signs and symptoms (Group B)

In Group C, out of 13 patients, none was cured and 7.69% (one patient) of the patients showed marked improvement. Also, 69.23% (nine patients) showed moderate improvement and 30.77% (three patients) showed mild improvement [Figure 1]. On statistical analysis, highly significant results were obtained in Dantashoola, Daurgandhya, Dantahrsha, and Aniyamit Ruja, whereas significant results were obtained in Shotha, and the result was insignificant in Chidrata, Krishnata, Paka and Srava [Table 4].

Table 4

Effect on signs and symptoms (Group C)

Discussion

Krimidanta (dental caries) is very common all over the world and involves all the age groups due to bad oral hygiene, lack of awareness about proper oral hygienic measures and bad habits like chewing tobacco, smoking, etc.[5] Krimidanta is silently progressive in nature. Generally, the disease Krimidanta is neglected by the patients till the pathogenesis become irreversible. It is observed that patients are worried of the time consuming and lengthy treatment like scaling, filling, root canal treatment and consulting the dentist regularly. Improper management in early stage leads the disease to the chronic phase. Dental caries is a problem related to the improper oral care; if at an early stage, the condition is neglected by the patients, the disease finally results in tooth loss. Dental caries affects mostly the population between the ages of 14 and 20 years, during which decay activity is the highest.[10] Though many theories are put forth to understand the exact mechanisms of caries formation, still the exact mechanism is not known. Dental caries is a microbial disease of the calcified tissues of the teeth, characterized by decalcification of the inorganic portion and destruction of the organic substances of the tooth.

Toothpaste was used by a majority of the patients (67.57%). This indicates that common toothpaste has no role in curing the disease. Exactly 51.35% of the patients were found to clean their teeth only once in a day, indicating lack of importance of oral hygiene after taking food or meals. It results in bacterial growth at the place of food collection, resulting in a dental plaque. Halitosis was observed in 70.27% of the patients, which indicates the disease Krimidanta itself. In modern dentistry, it has also been mentioned that the tooth is the primary host factor. It has been proved that the caries susceptibility of a tooth is inversely proportional to its fluorine, calcium and tin contents.[9] A bolus of food on the occlusal or incisor surface of a tooth, the area on the tooth surface where the food can stagnate for more time, is called non-self-cleansable area. It is highly susceptible for dental caries.

Conclusion

From the results and observations of this study, it can be concluded that Jaipatradi Gutika has provided better results in Dantashoola, Daurgandhya, Dantaharsha, Aniyamit Ruja, Shotha and Paka in Krimidanta Roga. Yavanadi Churna has provided good results in Dantashoola, Aniyamit Ruja, Dantaharsha and Daurgandhya. No result has been obtained in Chidrata (cavity formation), Krishnata (discoloration), Shotha (swelling), Paka (discharge) and Chaladanta (mobility) in this group. In a nutshell, the present clinical study has established that combined therapy gives better results than individual therapies.