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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 103-107

Management of Shitada (gingivitis) with Lodhradi gandusha and Shothahara mahakashaya kwatha: A case report


Department of Shalakya Tantra, All India Institute of Ayurveda, New Delhi, India

Date of Submission30-May-2020
Date of Acceptance07-Dec-2020
Date of Web Publication18-Jan-2021

Correspondence Address:
Dr. Mukhtar Alam
Department of Shalakya Tantra, All India Institute of Ayurveda, Sarita Vihar, New Delhi - 110 076
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JACR.JACR_23_20

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  Abstract 


Shitada (~gingivitis) is one among the Danta mulagata rogas (~periodontal diseases) characterized by spontaneous bleeding from gums. The gums become foul-smelling, blackish, soft, and sodden. Gums start receding and ripping off and so on. Gingivitis is caused mainly by the accumulation of debris, plaque, and calculus at the tooth margin, due to neglect of oral care. General prevalence of gingivitis is 50%, and this may be due to poor oral healthcare and lack of awareness. The management of gingivitis may not be satisfactory because of the mechanical removal of plaque by scaling, and the use of chemicals is much costly as well as time-consuming. In this case report, the patient with gingivitis for three years was intervened for four weeks with Lodhradi gandusha and Shothahara mahakashaya kwatha which showed a potential in the management of Shitada and better compliance was observed by the patient.

Keywords: Gandusha, gingivitis, Lodhradi churna, Shitada, Shothahara mahakashaya


How to cite this article:
Alam M, Rajagopala M, Bavalatti N, Kundal P. Management of Shitada (gingivitis) with Lodhradi gandusha and Shothahara mahakashaya kwatha: A case report. J Ayurveda Case Rep 2020;3:103-7

How to cite this URL:
Alam M, Rajagopala M, Bavalatti N, Kundal P. Management of Shitada (gingivitis) with Lodhradi gandusha and Shothahara mahakashaya kwatha: A case report. J Ayurveda Case Rep [serial online] 2020 [cited 2021 Feb 28];3:103-7. Available from: http://www.ayucare.org/text.asp?2020/3/3/103/307217




  Introduction Top


Oral health is of prime importance to all individuals and oral hygiene habits are inculcated in childhood itself, irrespective of the nationality or geographic location of an individual. Shitada (~gingivitis) is an inflammatory process limited to the mucosal epithelial tissues or inflammation of marginal gingiva surrounding the cervical portion of the teeth and the alveolar processes.[1] The prevalence of periodontal disease increases with age.[2] General prevalence of gingivitis is 50%, and this may be due to deficient oral healthcare and awareness at home and at school.[3] Risk factors for gingivitis include older age, poor oral hygiene, tobacco use, alcohol consumption, stress, malnutrition, and diabetes mellitus and other chronic diseases.[4] The most important factor that has been associated with gingivitis is plaque accumulation on the dental surface, resulting in an inflammatory reaction, with clinical signs of redness, edema, gingival bleeding, and sometimes pain, whereas the condition that persists with initially edematous gingiva may become more fibrotic.[5]

Shitada is the one among the Danta mulagata rogas characterized by Akasmata raktasrava (~spontaneous bleeding), Durgandhata (~halitosis), Krishnata (~blackish discoloration) of gums, Prakledata, mriduta (~soft and sodden), Vedana (~pain), Paka (~suppuration), Shotha (~inflammation), and Dantamasani shiryante and Pachanti parasparam (~gums starts receding and ripping off) and chiefly occurs due to vitiated Kapha and Rakta.[6] As far as the management is concerned, Aćharya Sushruta, Vagbhata, Chakradutta, Madhava, Yogaratnakara have recommended blood-letting, Nasya (~nasal therapy), Pratisarana (~medicated paste/powder application), and Gandusha (~medicated gargles). The contemporary management of gingivitis includes professional dental cleaning (scaling and root planning), dental restoration, and oral care. These procedures are costly as well as time-consuming. The last treatment of choice is surgery, which is not completely safe in all cases. Therefore, prevention and control of gingivitis are essential in every case.

Lodhradi gandusha[7] includes Lodhra (Symplocos recimosa Roxb.), Nagaramotha (Cyperus rotundus L.), and Rasanjana (extract of Berberis aristata DC.). These are having Kapha and Pitta shamaka properties along with anti-inflammatory, antimicrobial, antifungal, antioxidant properties.[8[,[9],[10]

Acharya charaka has mentioned Shothahara mahakashaya kwatha[11] which includes Patala (Stereospermum suaveolens Roxb.), Agnimantha (Premna integrifolia Willd.), Bilva (Aegle marmelos L.), Shyonaka (Oroxylum indicum L. Kurz), Kashmiri (Gmelina arborea Roxb.), Kantakari (Solanum xanthocarpum Schrad. and H. Wendl.), Brihati (Solanum indicum L.), Shalaparni [Desmodium gangeticum (L.) DC.], Prishaniparni [Uraria picta (Jacq.) DC.], and Gokshura (Tribulus terrestris L.). Since inflammation of the gingiva is commonly occurring symptom in patients of gingivitis, Shothahara mahakashaya kwatha has been selected for its management.


  Case Report Top


A 25-year-old, non-diabetic, normotensive female patient presented with complaints of swollen, bleeding gums, with bad breath for the past three years. Brushing aggravates bleeding. There was no history of any other systemic illness as well as no history of any previous medical or surgical treatment. Appetite was normal, and there was no history of tobacco use, smoking, or alcohol abuse.

On clinical examination, marginal and papillary gingiva appeared red and inflamed in the maxillary and mandibular arches. Gingiva appeared soft, spongy with smooth and glazing surface [Figure 1]. Further assessment revealed bleeding on probing on all teeth [Figure 2]. Profound halitosis was observed. Parameters used for the assessment of outcomes were gingival, bleeding, and debris indices. Gingival index score[12] was assessed and was found to be 2.084 before treatment, indicating moderate gingivitis with inflammation. Bleeding and debris indices[13] were assessed before treatment and were 1 and 2, respectively.
Figure 1: Before treatment, at 0thday, bleeding on probe, gingiva appears red, inflamed with blackish discoloration

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Figure 2: At 15th day, blood stains on probing decreased

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  Timeline Top


After taking written informed consent, treatment plan consisting of Lodhradi gandusha and Shothahara mahakashaya kwatha was planned. For preparation of Lodhradi gandusha, 5 g of coarse powder of Lodhradi yoga was boiled with 100 ml water in a vessel. Prepared decoction was filtered and allowed to cool for some time. Lodhradi kashaya with quantity of 45–60 ml was given for gargling and asked to hold the medicine for 5–10 min or till she can and then asked to spit and again continued with remaining Kashaya till it gets finished. The patient was asked to rinse the mouth with luke warm water after Gandusha. In addition to Gandusha, the patient was also administered orally Shothahara mahakashaya kwatha prepared in the dose of 10 g twice a day after meal. Both the therapies were continued for 30 days. (December 14, 2019 to January 12, 2020). Oral hygiene instructions were reinforced, i.e., brushing of teeth twice a day, oral irrigation after having meal, eating a balanced diet, and drinking plenty of water [Table 1].
Table 1: Timeline of the therapeutic intervention

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  Follow-up and outcomes Top


The patient was also counseled regarding the importance of follow-up and maintenance with special emphasis on motivation. The therapies were continued for 30 days, and the patient was followed at an interval of 15 days with significant relief in bleeding gums, bad breath, inflamed gingiva, etc., The symptoms of Shitada were assessed for subjective outcomes[14] [Table 2]. Gingival index, bleeding index scoring criteria, and debris index scoring criteria were used for objective assessment [Table 3],[Table 4],[Table 5]. Regular assessment and follow-up were done on 0, 15th, 30th, and 45th day [Table 1].
Table 2: Assessment of subjective outcomes

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Table 3: Gingival index

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Table 4: Bleeding index scoring criteria

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Table 5: Debris index scoring criteria

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  Discussion Top


Chronic inflammation of the gingiva is triggered by the accumulation of plaque and hence the primary cause of gingivitis. The above-mentioned case is a long-standing case of Shitada for the past three years. The patient presented with bleeding from gums, halitosis, and soft, spongy with smooth and glazing surface of the gingiva. Gradual improvement was noticed in bleeding, inflammation of gums, and halitosis. The patient became asymptomatic after one month of treatment. The gingival index is a well-validated and scientifically established parameter for assessing the severity of gingivitis. Marked improvement was seen in all the three indices, namely gingival, bleeding, and debris indices. Inflammation of the gingiva resolved completely. There was no bleeding and bad breath present after treatment [Figure 3] and [Figure 4].
Figure 3: During treatment, at 30th day, reduced bleeding on probing, marginal and papillary gingiva looks slightly red

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Figure 4: After treatment, at 45th day, discoloration of gums reduced, marginal and papillary gingiva inflammation resolved completely, no bleeding on probing

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Probable mode of action of therapies

The ingredients of Lodhradi gandusha have Kapha and Pitta shamaka properties along with anti-inflammatory, antimicrobial, antifungal, and antioxidant properties.[8],[9],[10] Gandusha is defined as “Asancharyo mukhe purne Gandushaha.[15] The action of Gandusha facilitates increase in mechanical pressure inside the oral cavity which stimulates pressure receptors (stretch reflex). Once the stretch receptor is stimulated, they send signals to salivary nuclei in the brainstem (pons and medulla).[16] As a result, parasympathetic nervous system activity increases and motor fibers of the facial (VII) and glossopharyngeal (IX) nerve trigger the output of saliva, which is bacteriostatic in action and prevents the growth of pathogenic microorganisms in the oral cavity. Antibody IgA present in the saliva also serves shield against microorganisms.[17] Thus, Gandusha increases local defense mechanism and endorses oral hygiene. Mucosal layer inferior to the tongue (sublingual) is thin and highly vascular enough to permit the rapid absorption of the lipid-soluble drugs. The Dravas (solutions) given for Gandusha are Sukhoshana (~warm), so raised temperature causes further increased vascular permeability, thereby intensifying absorption of drugs.[18]

Mandagni (~lack of digestive fire) is said to be responsible for manifestation of all kinds of diseases,[19] including Mukha rogas, keeping it in mind, and to enhance Agni (~digestive fire) as well as to break the pathogenesis of Shitada, Shothahara mahakashaya kwatha was administered. This kwatha reduces inflammation and also increases Agni, thereby pacifying the disease process.[20] Contents of Shothahara mahakashaya (Dashamoola) kwatha are also having properties of Kapha-Vata shamana, anti-inflammatory, analgesics, antioxidant, relieve Ama dosha, and strengthen Rasa, Mamsa dhatus of the body.[21]

One of the most important determinants of treatment outcomes is patient compliance. The willingness to perform adequate oral hygiene measures and receive timely periodic recalls and treatment is essential for a successful outcome. The drugs given in this case showed no adverse effects and easy to administer, and thus, better patient compliance was observed.


  Conclusion Top


In modern life, however, due to lack of time and negligence, oral hygiene is not properly maintained, which leads to various oral diseases. This study concluded that administration of Lodhradi gandusha along with Shothahara mahakashaya kwatha gave promising results in Shitada (~gingivitis). To further prove the efficacy and to establish this therapy, well-designed and planned study on large sample size is required.

Declaration of patient consent

The authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Unadkat R, De S, Manjusha R. Clinical efficacy of “Bhadra Mustadi Paste” and “Nagaradi Kwatha Gandusha” in Shitada (gingivitis). AYU 2011;32:218-24.  Back to cited text no. 14
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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