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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 9
| Issue : 2 | Page : 84-88 |
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Clinical Study to Evaluate the Anti-Plaque Effect of Neem dantakashtha
Pankaj Kumar1, Durgawati Devi2, Sharad Bhatnagar3
1 Department of Swasthavritta and Yoga, All India Institute of Ayurveda, New Delhi, India
2 Department of Swasthavritta and Yoga, National Institute of Ayurveda, (Deemed to be University), Jaipur, Rajasthan, India
3 Consultant Dentist in Department of Shalakya Tantra, National Institute of Ayurveda, NIA Hospital, (Deemed to be University), Jaipur, Rajasthan, India
| Date of Submission | 11-Jul-2022 |
| Date of Decision | 12-Aug-2022 |
| Date of Acceptance | 05-Sep-2022 |
| Date of Web Publication | 20-Feb-2023 |
Correspondence Address:
Pankaj Kumar
Department of Swasthavritta and Yoga, All India Institute of Ayurveda, New Delhi
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/AYUHOM.AYUHOM_35_22
Introduction: Dental plaque is the community of microorganisms found on a tooth surface as a biofilm, embedded in a matrix of polymers of host and bacterial origin. Progression and buildup of dental plaque can give rise to tooth decay – the localized destruction of the tissues of the tooth by acid produced from the bacterial degradation of fermentable sugar – and periodontal problems such as gingivitis and periodontitis. Aim: The aim of this clinical study is to evaluate the anti-plaque effect of Neem (Azadirachta indica) Dantakastha. Materials and Methods: The present study was an open randomized controlled interventional study wherin 30 apparently health people were participated. Registered volunteers were divided equally into two groups: Group A and Group B. Group A – the control group did not receive any intervention. This group was on its daily dental hygiene routine practice. Group B – the test group was subjected to do two-time toothbrushing with Nimba plant twig for a duration of 1 month. Results: In this study, the plaque index of Silness and Loe was measured before and after the completion of the trial period both in the control and interventional group. There are not any significant changes in Group A (P = 0.5879). There are highly significant changes in intervention Group B (P < 0.0001). Conclusion: Hence, it is concluded that Neem Dantakastha has a good effect as an anti-plaque agent as compared to the control group.
Keywords: Anti-plaque agent, Dantakashtha, Neem, oral hygiene
How to cite this article:
Kumar P, Devi D, Bhatnagar S. Clinical Study to Evaluate the Anti-Plaque Effect of Neem dantakashtha. AYUHOM 2022;9:84-8 |
| Introduction | |  |
Acharya Charaka says health is the principal tool to achieve all the objects of pursuits, namely Dharma, Artha, Kama, and Moksha.[1] Swasthavritta deals with this aspect of Ayurveda and paves the way for a healthy life span. Hence, many principles have been described to fulfill this purpose, and Dinacharya (daily regime) is one of those.[2] It includes various activities related to cleansing and immunity boosting. Dantadhawan (one of the components of the daily regime according to Aacharya Charaka) has been indicated for cleansing teeth, and various Dantakastha (plant twig) have been described for it.
Need of the study
In this global fast-moving economy and jet life, it is of utmost importance to give the fullest possible level of performance in our work for that we need a healthy body in terms of all physical, mental, social, and spiritual aspects. To achieve this, a healthy state and long-life Aacharya Charaka give great importance to the prevention of disease and preservation of health.[3] For this, our Aacharyas also gave the proper pathway in terms of Dincharya regimens, Ritucharya, and many more things. Among them, Dantadhawan, Kaval, and Gandush are also included.
However, the fact is that in this modern era, the globally accepted oral hygiene practices are much more different than that in ancient times. Now, everyone is habitual of using toothbrushing with toothpaste and gargles with mouth wash which is full of chemical substances along with harmful ingredients such as preservatives and many more things added to increase the efficacy of these products.
No, doubts these chemical-containing objects fulfill the fast-acting need of this global time but also carry side effects. Commonly used mouthwash chlorhexidine can cause many side effects including brown discoloration of teeth, includes retroactive materials, and there is taste perturbation.
When we see the Ayurvedic literature about Dantadhavana, we found that they have broad-spectrum health benefits as compared to prevailing oral hygiene practices. It seems that these practices cover the preventing aspect of oro-dental disease less as compared to the ancient oral hygiene practices. However, it is believed that ancient Dantadhavana procedures are not sufficient to meet the need for oral health problems in this modern era. This time is also a time of advertisement and modern oral hygiene products are good in this field, this fact also biases people while choosing between ancient and modern dental hygiene practices. Moreover, they go with the thing which they listen to or see all the time in media, therefore they also suffer the side effects of these chemical-based oro-dental products. Despite this, mainly the use of chewing sticks/Dantakashtha described by Acharyas does not have these types of side effects and even they have amazing properties, i.e. Balya, Varnya, and Medhya as described in Bhavaprakasha Samhita.[4]
Dental diseases are a major health problem worldwide; and among these, dental plaque and periodontitis are the most common global health problems.[5] The use of Dantakastha is well documented in Charaka Samhita to avoid these oral diseased conditions.[2] In Astanga Hridya, it is clearly mentioned that Katu, Tikta, and Kashaya Rasa predominant Dantakastha are best for Dantadhawan.[6] Dantakastha or the classical way of Dantadhawan described in Ayurveda is the most suitable and convenient to attain oral hygiene in comparison to the contemporary way of toothbrushing or oral wash. Medicinal plants for Dantadhawan are believed to have anti-plaque, anti-bacterial properties which are beneficial for the prevention and treatment of oro-dental diseases. Hence, there is a need to establish such type of anti-plaque agent which is not harmful and equally or more effective as compared to prevailing anti-plaque agents. Hence, here, this study was designed to assess the anti-plaque activity of Neem (Azadirachta indica) Dantakashtha.
Here, an attempt was made to study the effects of classical Dantakastha for anti-plaque agents in comparison to modern or contemporary oral health practices. Furthermore, this study gives new hope for research work to be done in this area by taking other subjective criteria to know more about the oral health coverage to make the ancient oral hygiene practice of Dantadhawan more popular and to be accepted globally with respect.
The aim of this study is to determine the role of Neem Dantakastha as an anti-plaque agent with the objective as to know how effective is Neem Dantakastha as an anti-plaque agent in terms of the plaque index (PI) of Silness and Loe.[7]
Process of plaque formation
Dental plaque formation usually starts immediately after toothbrushing. After some minutes of brushing, saliva-derived glycoprotein deposition starts to cover the tooth surface which is referred to as pellicle. Pellicle formation is the first step in plaque formation. The pellicle is then colonized by Gram-positive such as Streptococcus sanguis, Streptococcus mutans, and Actinomyces. With all these, the pellicle becomes viscous and is known as plaque. Bacterial cells interact with pellicle components enabling plaque to firmly adhere to the tooth surface.[5]
When bacteria start adhering to the tooth surface, the formation of a biofilm begins, followed by a lag phase due to which a change in genetic expression occurs. A phase of rapid growth follows that and an “exopolysaccharide matrix” originate. In the last state, this biofilm achieves growth steadiness. After that surface detachment and exuviating occurs, and new bacteria or pathogen are acquired.[5]
| Materials and Methods | | |
It was an open-randomized control trial. The study was granted by the Institutional Ethical Committee, National Institute of Ayurveda, Jaipur Vides Letter No. IEC/ACA/2019/1-95. This study was conducted after getting it registered in the Clinical Trial Registry of India with registration no. CTRI/2020/08/027211 dated August 18, 2020.
Inclusion criteria
Apparently healthy individuals within the age group of 18–60 years not under any sort of medication for the last 1 month with their consent were included in the study.
Exclusion criteria
- Tobacco users
- Orthodontic appliances or removable partial dentures or fully crowned teeth
- Pregnancy and lactation
- Subjects with severe malalignment of teeth.
Randomization
Randomization was done with the help of random number table, and the method of allocation concealment was with SNOSE.
Method of collection of data
Thirty apparently healthy individuals satisfying inclusion criteria were enrolled from NIA Campus and Jaipur City only after their signed informed consent form. A special case proforma was designed incorporating all the details and examination procedures. All the particulars related to each volunteer were recorded in their respective case proforma. Then they were equally divided into Groups A and B. Group A (control group) did not receive any intervention. This group was on its daily dental hygiene routine practice. Group B (test group) was subjected to two-time Dantadhawan with Nimba (A. indica) plant twig of length equal to 12 Angula and diameter equal to the little finger.
Assessment criteria
Plaque index (PI) of Silness add Loe [Figure 1].
Selection of teeth
Particular teeth were selected as per Silness and Loe index.
Area inspected
Four (distal, facial, mesial, and lingual) gingival areas are examined in this PI.
Standard operating procedure (SOP) of Silness and Loe index
”Dry the teeth and examine visually using adequate light, mouth mirror, and probe or explorer. Evaluate bacterial plaque on the cervical third; pay no attention to plaque that has extended to the middle or incisal thirds. Probe to test the surface, when no plaque is visible. Pass the probe or explorer across the tooth surface in the cervical third and near the entrance to the sulcus. When no plaque adheres to the probe tip. The area is scored as 0. When plaque adheres, a score of 1 is assigned.
Use a disclosing agent, if necessary, to assist evaluation of the 0–1 scores. When the PI is used in conjunction with the gingival index (GI), the GI must be completed first because the disclosing agent masks the gingival characteristics.
Include plaque on the surface of the calculus and on dental restorations in the cervical third in the evaluation.”
Criteria
- ”No plaque”
- ”A film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque only be recognized after application of disclosing agent or by running the explorer across the tooth surface”
- ”Moderate accumulation of the soft deposits within the gingival pocket that can be seen with the naked eye or on the tooth and gingival margin”
- ”Abundance of soft matter within the gingival pocket and/or the tooth and gingival margin.”
Scoring
A. “PI I for Area”
”Each area (distal, facial, mesial, and lingual or palatal) is assigned a score from 0 to 3.”
B. “PI I for a Tooth”
”Scores for each area are totaled and divided by 4.”
C. “PI I for Groups of Teeth
Scores for individual teeth may be grouped and totaled and divided by the number of teeth.”
D. “Pl I for the Individual
Add the scores for each tooth and divide by the number of teeth examined. The Pl I score ranges from 0 to 3.”
Statistical software used
GraphPad Software 2365 Northside Dr. Suite 560 San Diego, CA 92108.
Statistical test used
Wilcoxon signed-rank test and Mann–Whitney test were used.
Statistical analysis
At 5% level of significance.
| Results | | |
The present study showed that maximum, i.e., 22 volunteers (73.33%) belong to the age group of 18–30 years, and 8 volunteers (26.67%) were in 31–45 years of age group, and 56.66% volunteers were married while 43.34% volunteers were unmarried. Among registered volunteers, 66.67% volunteers were found to have normal sleep, 13.33% had disturbed sleep, and 20% volunteers had excessive sleep patterns. In the present study, 26.67% of volunteers were revealed to have a vegetarian diet, while 73.33% were found to have a mixed diet. In this study, 93.33% of volunteers were habitual of tea, while others did not have any addiction. To see the effect of intervention before–after measurement of PI was done and to test its significance, Wilcoxon signed-rank test was applied. After this, it was revealed that changes in the control group were nonsignificant (P = 0.5879), while in Group B, there was a significant difference (P < 0.0001) in the measurement of PI before and after the trial [Table 1]. To compare the effects in-between both groups, Mann–Whitney test was applied. After that, it was revealed that there is a moderate significant difference (P = 0.0025) in-between Groups A and B. Group B showed better results than Group A [Table 2].
| Discussion | | |
When we see the process of plaque formation, it gets clear that just after the removal of debris over the teeth, i.e. just after the mechanical cleaning of the teeth surface, plaque formation starts naturally. Hence, they need periodic cleaning in terms of toothbrushing in either way, i.e. by contemporary oral hygiene practices or traditional oral health practices. However, in this study, when the effect of interventions was evaluated in the groups, it was revealed that changes in Group A were nonsignificant, while in Group B, there was a significant difference in the measurement of the PI before and after the trial. It was because of the properties of Neem Dantakastha.
Probable mode of action of Neem Dantakastha
Oral hygiene is important as dental biofilms may become acidic causing demineralization of the teeth (also known as dental caries). Neem Dantakastha has Tikta Rasa, Laghu and Ruksha Guna, Sheeta Virya, and Katu Vipaka. When we talk about the Karma, Neem has Kaphahara, Pittahara, Vishaghna, Kandughna, Vranashodhanakara, and Hridayavidahashantikara.[8] When we talk about the properties of good-quality Dantakasthas, they have Putihara, Krimighna, Kandughna, Varnasodhana, and Varnaropana properties.[9]
The plants used in this study basically has opposite constitution from the mouth environment such as Tikta Rasa and Katu Viapaka.[10] These Rasa are opposite to the Kapha, so they pacify the vitiated Kapha in the mouth and remove the debris collected in the mouth which are the result of digestion and metabolism. Katu Vipaka helps to keep the mouth clean by scrapping and releasing Mala from its respective place.[11] It develops taste for food. Hence, it stimulates the taste buds. Tikta Rasa has mouth-absorbing property.[12] It also stimulates taste buds and develops normal taste. Overall, Rasa constitution easily cleanses the mouth and gives up a fresh and pleasant feeling and improves the taste and also maintains the wear-and-tear process occurring in daily routine.
It is the general indication and in special condition, certain other Rasa constitution has been described, i.e. a person with Pitta constitution should use a bitter stem-like Katunimb, a person with Kapha constitution should use pungent such as Karanja person with Vatapitta constitution should use a stem of Nyagrodha.[13] In certain classics, Dantadhavan Churna is also mentioned and should be used with Dantadhavan, ingredients of Dantashodhan Churna include the plants having cleansing, evacuating, healing, anti-infective, and mouth freshening properties.[14]
Neem (A. indica) plants parts show an antimicrobial role through an inhibitory effect on microbial growth/potentiality of cell wall breakdown. Azadirachtin, a complex tetranortriterpenoid limonoid present in seeds, is the key constituent responsible for both antifeedant and toxic effects in insects.[9]
| Conclusion | | |
The plants having Katu, Tikta, and Kashaya Rasa prominent are best for the selection of Danatkastha. Neem Dantakastha has been found very effective as an anti-plaque agent. Neem Dantakastha does not have any ill effects such as discoloration or enamel disintegration.
Financial support and sponsorship
This study was financially supported by National Institute of Ayurveda, Jaipur, Deemed to be University-302002.
Conflicts of interest
There are no conflicts of interest.
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| 9. | Alzohairy MA. Therapeutics role of Azadirachta indica (Neem) and their active constituents in diseases prevention and treatment. Evid Based Complementary Altern Med 2016;2016. |
| 10. | Vagbhatta. Astanga Haridya: Sutra Sthana, Dinacharya Adhaya 2/2. Nirmala Hindi Commentary, Dr. Brahmananda Tripathi. Delhi: Chaukhambha Sanskrita Pratisthan; 2011. p. 26. |
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| 13. | Athwale VB. Dentistry in Ayurveda. Delhi: Chaukhambha Sanskrita Pratisthana; 1999. p. 8. |
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[Figure 1]
[Table 1], [Table 2]
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