|Year : 2011 | Volume
| Issue : 2 | Page : 218-224
Clinical efficacy of "Bhadra Mustadi Paste" and "Nagaradi Kwatha Gandusha" in Shitada (Gingivitis)
Rajshree Unadkat1, Subrata De2, R Manjusha3
1 Lecturer, Department of Shalakya Tantra, International Centre for Ayurvedic Studies, Gujarat Ayurved University, Jamnagar, India
2 Director, Research & Development Centre, Waghaldhara, India
3 Associate Professor, Department of Shalakya Tantra, Institute for Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
|Date of Web Publication||2-Feb-2012|
C 19/A, Medical Campus, Professor's Quarters, MP Shah Medical College, Jamnagar
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Shitada is one of the Dantamulagata Rogas mentioned by Acarya Susruta under the heading of Mukha Rogas. It is characterized by symptoms like spontaneous bleeding, halitosis, blackish discoloration of gums, and so on. The symptomatology of Shitada can be compared with gingivitis, which is caused mainly by the accumulation of debris, plaque, and calculus at the tooth margin due to ignorance of oral care. It can progress into periodontitis - the disease in which the firmness, contour, and position of the gums are altered and teeth become mobile. The prevalence of gingivitis is as high as 50% in most of the population. In the present study, a total of 33 patients were registered in three groups. Bhadramustadi yoga has been used in paste form for local application along with Nagaradi Kwatha Gandusa in Group A and in powder form for Pratisarana along with Nagaradi Kwatha Gandusa in Group B. In Group C (Control) Sphatika Jala was used. The patients were diagnosed and assessed on the basis of Ayurvedic as well as modern classical signs and symptoms. Further assessment was done with the different indices used in modern dentistry. All the signs and symptoms were given a score depending upon the severity, to assess the effect of the drugs objectively. The effect of therapy was highly significant in group A in most of the signs, symptoms, and indices; and in group B it was highly significant in some signs and symptoms.
Keywords: Bhadramustadi yoga , bleeding gums, Dantamula, Gingivitis, Nagaradi Kwatha, oral hygiene, Shitada
|How to cite this article:|
Unadkat R, De S, Manjusha R. Clinical efficacy of "Bhadra Mustadi Paste" and "Nagaradi Kwatha Gandusha" in Shitada (Gingivitis). AYU 2011;32:218-24
|How to cite this URL:|
Unadkat R, De S, Manjusha R. Clinical efficacy of "Bhadra Mustadi Paste" and "Nagaradi Kwatha Gandusha" in Shitada (Gingivitis). AYU [serial online] 2011 [cited 2019 Jul 18];32:218-24. Available from: http://www.ayujournal.org/text.asp?2011/32/2/218/92590
| Introduction|| |
Shitada is considered by Acaryas Susruta to come under 'Dantamulagata Rogas',  which is a group of the Mukha Rogas and is characterized mainly by spontaneous bleeding from the gums, without any injury, and occurs due to vitiated Kapha and Rakta.  The symptomatology of Shitada can be compared with Gingivitis. 
Gingivitis, an inflammation of the gingiva, occurs widely in most populations, affecting both children and adults. The high prevalence of gingivitis is approximately 50%  in the general population.
Gingivitis is caused mainly by accumulation of debris, plaque or calculus on the teeth margin  mostly due to negligence of oral care. It is a state incompatible with good oral health. It can progress to more serious conditions like periodontitis, which is responsible for tooth loss, by altering the contour and position of the gingiva.  Gingivitis is reversible. With careful early treatment and good oral hygiene, gingival harmony can be restored. 
At present, the modern management of Gingivitis is not satisfactory, as mechanical removal of plaque and debris by scaling causes trauma to the gums; use of chemicals, that is, mouth wash, irrigation, and so on are expensive as well as time consuming, and the last treatment of choice is surgery, which is not completely safe in all cases. Therefore, prevention and the control of Gingivitis are essential in every case.
In Ayurveda; Susruta and other authors have recommended Bloodletting, Nasya, Pratisarana, Gandusa, and so on, in the management of Shitada. The importance of oral hygiene was well-known to the early Hebrews. The procedures for the cleanliness of oral cavity are a very important part of Dinacarya. The Acaryas have mentioned Dantadhavana, Gandusa, Kavala, Pratisarana, Jihvanirlekhana, and so forth, as a part of day-to-day life, to keep the oral cavity in a healthy state. 
It is a fact that if a person does not follow the rules of oral hygiene, he suffers from various MukhagataRogas. There is no doubt; that oral hygiene also has an important role in the maintenance of general body health, as infective focus in teeth can cause systemic diseases. 
Although, the prevalence of the disease Shitada is very high, very few studies have been carried out on Shitada as well as on the awareness of oral hygiene. A good number of patients present with gingivitis, to the Outpatient Department (OPD). Due to lack of oral care awareness, busy life, and no apparent difficulty; the patients ignore the disease and it progresses to advance stages.
In a clinical study, by Krishna Makadia, Dr. Manjusha R., et al., 2004, encouraging results with BhadramustadiCurnapratisarana and Gandusa with Nagaradikwatha for gingivitis, were reported. 
Ayurvedic medicines are undergoing drastic changes in the present era. Toothpaste is the most widely used form for dental disorders as well as for oral care. The powder form is inconvenient for the patients and has more chances of contamination from the atmosphere. Here an attempt has been made to convert it into the paste form, as a part of continuation of the above study, to compare the efficacy of the same medicine in a different form.
In the present study, Bhadramustadi yoga is used in the paste form for local application with a soft brush, using the Bass technique  of brushing, along with the Nagaradi KwathaGandusa in the Trial group, that is, Group A, whereas, in Group B the same Yoga is used in powder form for local application along with Nagaradi Kwatha as the standard control drug and Sphatikajala was used in control Group C.
Aims and objectives
- To evaluate efficacy of Bhadramustadi paste and Gandusa with Nagradi Kwatha
- To compare the efficacy of curna and paste form
| Materials and Methods|| |
The patients attending the OPD of the Shalakya Department of I.P.G.T. and R. A. hospital, Gujarat Ayurved University, Jamnagar, provided the material for clinical study and selection was done randomly irrespective of age, sex, religion, race, occupation, and so on, fulfilling the criteria of selection and eligibility for the study.
- Patients presenting with signs and symptoms of Shitada (Gingivitis), described as per Ayurvedic and Modern texts.
- Patients were diagnosed clinically with the help of a dental mirror, dental probe, and periodontal pocket probe, fulfilling the criteria of Shitada as well as gingivitis.
Plan of work
- Patients with marked pus discharge from the gums
- Patients with a periodontal pocket
- Patients having any systemic disease that could cause gingivitis
- Patients using any other systemic drugs, which may alter the result of the study
Grouping and treatment schedule
- Research proforma:
A detailed research proforma was prepared to study the patients as well as the disease.
Routine investigations of blood, urine, and stool were carried out before treatment to rule out any systemic diseases. The microbial study of the gingival swab was done by bacterial culture in some patients.
Group A: Drugs: Bhadramustadi paste for local application with tooth brush, followed by Nagradi Kwatha Gandusa.
Dose: Bhadramustadi Paste: Two applications on soft tooth brush twice a day.
Nagradi Kwatha: 20 ml Kwatha for Gandusa twice a day after paste application.
Duration: 45 days.
Group B: Drugs: Bhadramustadi Curna for local application followed by Nagradi Kwatha Gandusa.
Dose: Bhadramustadi Curna - 2 g with honey twice a day.
Nagradi Kwatha - 20 ml Kwatha for Gandusa twice a day after application.
Duration: 45 days.
Group C: Drug Sphatikajala
Dose: 1 g Suddha Sphatika diluted in 250 ml water given for Gandusa
Duration: 45 days.
Oral hygiene methods and their importance in the reversal of the disease were explained to the patients of all the groups, and brushing the teeth properly was suggested for cleaning of the teeth.
Bhadramustadi paste [Curna (B.R.61/16)]
The Bhadramustadi Curna contains drugs, which were selected by virtue of their properties. It was meant for Pratisarana with honey in Group B, while the paste that was prepared out of 100 mesh fine powder of the same yoga was given for local application with soft tooth brush in Group A.
The ingredients of Bhadramustadi yoga are:
Nagaradi Kwatha (S.Ci. 22/11)
The Nagaradi Kwatha was selected for Gandusa along with the application of toothpaste as well as Pratisarana. It was meant for oral hygiene supplementation therapy in the management of Shitada.
The ingredients of Nagaradi Kwatha are:
A period of three months was planned for follow-up study, to evaluate the recurrence after treatment. Instructions regarding the special care of Ahara and Vihara were given and fibrous, non-sticky food like fruits, vegetables, and so on were advised.
Criteria for assessment of results
The effect of treatment was assessed subjectively by clinical observation, on the basis of relief in the signs and symptoms of the disease.The scoring pattern adopted for the study was prepared depending upon the severity of the symptoms like Akasmata Raktasrava (Bleeding gums), Sotha (Inflammation), Siryamana Dantamamsa (Gingival recession), Krisnata (Discoloration of gums), Daurgandhya (Halitosis), Vedana (Pain), Dantamamsa Mriduta (Sponginess), Dantamamsa Klinnata (Snigdhata), Paka (Pus discharge), and Caladanta (Tooth mobility). The scoring was given from 0 to 4 depending upon the severity. The patients were objectively accessed on the basis of the gingival index  and the bleeding index. Oral hygiene was assessed with the Simplified Oral Hygiene Index. 
Criteria for assessment of the total therapy
The total effect of the therapy was assessed on the basis of subjective and objective criteria and patients were grouped into the following five categories:
A total of 40 patients were registered for the present clinical study, out of them 33 patients completed the treatment and seven left the treatment against medical advice. The patients were divided into three groups by the random sampling method. In Group A 13 patients, Group B 10 patients, and in Group C 10 patients, completed the treatment.
In Group A the patients were advised to use Bhadramustadi paste with a soft toothbrush and brush twice per day, once in the morning and once in the evening, using the Bass method.
The trial drug, the Bhadramustadi paste, was prepared with Bhadramustadi Curna (100 mesh fine powder) 40% mixed with the common base of toothpaste 60%. Toothpaste was prepared at the pharmacy of Gujarat Ayurved University, Jamnagar.
| Observations and Results|| |
Patients (33.33%) reported in the age group of 30-40 years. A majority of the patients were female, that is, 87.90%; majority of the patients were Hindus, that is, 84.85%; 54.55% patients included in the study belonged to the lower middle class. Raktasrava, Sotha, and Mriduta were presented by all the patients. Daurgandhya was one of the complaints in 96.97% patients, followed by Krisnata and Vedana (87.88% each) and Siryamanta in 84.85% cases. Paka and Caladanta were complaints of 21.21 and 18.18% patients, respectively; and 90.91% had gingivitis of moderate grade. A maximum of 66.67% patients brushed their teeth once daily to keep the oral cavity clean.
Evaluation of the effect of treatment in Group A
Relief of 91.89% was observed in Raktasrava, which was statistically highly significant at the level of P < 0.001. 77.88% relief was obtained in Sotha, which was statistically highly significant at the level of P < .001. Relief of 66.67% was obtained in Siryamana Dantamamsa, which was statistically highly significant at the level of P < 0.001. Relief of 85.80% was observed in Krisnata, which was statistically highly significant at the level of P < 0.001. Relief of 100% was obtained in Daurgandhya, which was statistically highly significant at the level of P < 0.001. Up to 94.52% relief in Vedana was found in Group A, and it was also statistically highly significant at the level of P < 0.001, Mriduta up to 92.59%, and Klinnata up to 91.30%, were also relieved, and the results were statistically highly significant. Relief in Paka and Caladanta (100.00%) was seen, which was statistically significant at the level of P < 0.02 (P < 0.001) [Table 1] and [Table 2].
Evaluation of the effect of treatment in Group B
- The Gingival Index was improved up to 74.36%, which was statistically highly significant at the level of P < 0.001.
- The Bleeding index was also improved up to 78.43%, which was statistically highly significant at the level of P < 0.001.
- Similarly, OHI-S index was improved up to 74.19% and the improvement was statistically significant.
Relief of 55.00% was obtained in Raktasrava, which was statistically highly significant at the level of P < 0.001. Relief of 50.99% was observed in Sotha, which was statistically highly significant at the level of P < 0.001. Patients in Group B did not show considerable relief in Siryamana Dantamamsa and the difference was also not significant statistically ( P > 0.05). Krisnata was relieved up to the extent of 46.15%, which was statistically significant at the level of P < 0.01. Relief of 65% was obtained in Daurgandhya, which was statistically highly significant at the level of P < 0.001. Relief of 64.29% was observed in Vedana, which was statistically highly significant, P < 0.001. Relief of 60.00% was obtained in Mriduta, which was statistically significant at the level of P < 0.01. Klinnata was relieved up to the level of 80%, which was statistically highly significant at the level of P < 0.001 [Table 3] and [Table 4].
Evaluation of the effect of treatment in Group C
- Improvement of 46.67% was obtained in the Gingival Index, which was statistically highly significant at the level of P < 0.001.
- Improvement of 40.30% was observed in the Bleeding Index, which was statistically highly significant at the level of P < 0.001.
- The OHI-S index was improved up to the extent of 45.04%, which was statistically highly significant, P < 0.001.
Only 30% relief was obtained in Raktasrava, which was statistically significant at the level of P < 0.01. A very negligible effect was observed in Sotha relief (9.52%), Krisnata relief (6.67%), and Klinnata relief (10.00%) among Group C patients, and statistically also the difference was not significant P > 0.05. Relief of 44.44% in Daurgandhya and 22.22% in Vedana was obtained, which was statistically significant at the level of P < 0.01 and < 0.01 and P < 0.05, respectively. Siryamana, Dantamamsa, Mriduta, and Caladanta did not show any relief in Group C patients [Table 5] and [Table 6].
- The Gingival index and Bleeding index did not show any improvement (7.14 and 8.06%, respectively), which was statistically not significant, P > 0.05.
- Improvement of 42.40% was observed in the OHI-S Index, which was statistically highly significant at the level of P < 0.001.
| Disscussion|| |
Shitada (Gingivitis) is highly prevalent in India as well as the rest of the world. It is caused mainly by plaque accumulation on the teeth due to lack of oral hygiene. Application of Bhadramustadi paste with toothbrush, using a proper method, can remove the plaque, reduce the swelling, and prevent the infection with its best therapeutic action. Gandusa is beneficial in the sodhana of the oral cavity. Retention of the medicine in the oral cavity loosens the calculus and gives a mechanical massage to the gingiva. Absorption of the drug reduces the infection. One-third of the patients in this series, that is, 33.33%, were found to be suffering from Shitada since the last 15 months or more. It indicates that the disease is chronic in nature. A maximum number of patients (93.94%) used tooth brush as a means to oral hygiene and 75.76% patients adopted horizontal brushing technique. The tooth brush can clean inter-dental areas, pits, fissures, and so on, provided the selection of the toothbrush and the brushing technique is proper. Due to lack of knowledge of the correct brushing technique, the plaque was not removed completely, therefore, proper selection of brush and technique should be explained to the patients. In Group C, that is the control Group, also mild improvement in sign and symptoms and also improvement in OHI was found. It indicated that proper brushing technique and oral hygiene was also important for the maintenance of oral health. Total effect of therapy has been depicted at Graph 1.
| Conclusion|| |
A conclusion can be drawn as follows from the study.
- Eating fibrous and less sticky foods like fruits, pulses, vegetables, and the like keep the body healthy and preserve oral hygiene.
- Oral care methods mentioned in ancient texts should be properly followed in a healthy condition as well as in a diseased condition.
- There is need to increase awareness about oral hygiene in the society. Various programs for oral care methods with regard to its importance and diseases resulting from its negligence, in various age groups of the society, should be conducted.
- In nutshell, it is concluded from this study that Bhadramustadi paste application with a soft tooth brush along with Nagaradi Kwatha Gandusa is more effective than Bhadramustadi Curna Pratisarana and Nagaradi Kwatha Gandusa in the management of Shitada (Gingivitis) as well as this therapy (Probable mode of action at [Figure 1]) is useful in removing and controlling plaque and calculus. Thus it is a better remedy for maintaining oral hygiene.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]