E-ISSN:2456-3110

Research Article

Mukh Daurgandhya

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 11 December
Publisherwww.maharshicharaka.in

Evaluation of Chaturjaat Kawala in the management of Mukh Daurgandhya and its Antimicrobial Effect in Oral Hygiene

Rajpurohit H.1*, Kumar Mishra P.2, Parashar R.3
DOI: http://dx.doi.org/10.21760/jaims.7.11.6

1* Hemant Rajpurohit, Post Graduate Scholar, Dept. of Swasthavritta and Yoga, University College of Ayurveda, DSRRAU, Jodhpur, Rajasthan, India.

2 Pramod Kumar Mishra, Professor & HOD, Dept. of Swasthavritta and Yoga, University College of Ayurveda, DSRRAU, Jodhpur, Rajasthan, India.

3 Rahul Parashar, Assistant Professor, Dept. of Swasthavritta and Yoga, University College of Ayurveda, DSRRAU, Jodhpur, Rajasthan, India.

Oral illnesses can develop as a result of poor oral hygiene. Kawala process is mentioned in Ayurveda texts to treat oral illnesses. Chaturjaat and its Mukhgandh Har property is mentioned in ‘Karpuradi Varg’ of Bhavprakash Nighantu. Kawala of Chaturjaat made from Hima process is used here to treat Mukh Daurgandhya and to see its effect in antimicrobial study. Two groups of 30 patients each are included in this study. One group was given Chaturjaat while other 30 were given lukewarm water Kawala. It was seen that Chaturjaat Kawala was more effective in subjective criteria of oral hygiene as well as in antimicrobial study.

Keywords: Oral hygiene, Chaturjaat, Mukh Daurgandhya, Kawala, Hima

Corresponding Author How to Cite this Article To Browse
Hemant Rajpurohit, Post Graduate Scholar, Dept. of Swasthavritta and Yoga, University College of Ayurveda, DSRRAU, Jodhpur, Rajasthan, India.
Email: 		Hemant Rajpurohit, Pramod Kumar Mishra, Rahul Parashar, Evaluation of Chaturjaat Kawala in the management of Mukh Daurgandhya and its Antimicrobial Effect in Oral Hygiene. J Ayu Int Med Sci. 2022;7(11):34-40.
Available From
https://www.jaims.in/jaims/article/view/2166

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-10-31 2022-11-02 2022-11-09 2022-11-16 2022-11-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Hemant Rajpurohit, Pramod Kumar Mishra, Rahul Parasharand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Rajpurohit R et al: Chaturjaat Kawala in the management of Mukh Daurgandhya

Introduction

The fundamental goal of Ayurveda is to maintain and promote good health, with disease cure coming in second. In Ayurveda, "Swasthya Samrakshana" refers to preventive health treatment. It effectively conveys the significance of personal hygiene. The ultimate aim of any medical science is for attainment of level of health, this enables every individual to lead socially and economically productive life. In this regard Ayurveda stands first, as it is the science, which primarily aims at preservation of positive health.

The Mukha, or oral cavity, is one of the most significant parts of the Urdhwajatru because it acts as a mirror of body health by acting as the entryway to the alimentary canal. Oral illnesses can develop as a result of poor oral hygiene. Susruta describes the Mukharogas in Nidana Sthana (diseases affecting the oral cavity). Susruta divided Mukha's sickness into seven sub-sites, namely Austa, Danta, Dantamula, Jihwa, Talu, Kantha and Sarvasar.

According to Govt. of India, there are 253 million adolescents in the age group 10-19 years in India. This age group comprises of individuals in a transient phase of life requiring nutrition, education, counselling and guidance to ensure their development into healthy adults. They are susceptible to several preventable and treatable health problems, like early & unintended pregnancy, unsafe sex leading to STI/HIV/AIDS, nutritional disorders like malnutrition, anaemia & overweight, alcohol, tobacco and drug abuse, mental health concerns, injuries & violence.

Dental (oral) problems are caused by microorganisms in our mouth. Natural gargle may naturally eradicate bacteria in our mouth without the use of hazardous chemicals, and it is also more acceptable and safer than synthetic medications and mouthwashes containing alcohol.

Here, Chaturjaat Churna having property of Mukhgandhhar which is mentioned in Karpuradi Varg of Bhavprakash Nighantu.[1]

Mukha Rogas is well explained by its name in Sushruth Samhita and Ashthang Hridhya. Acharya Sushruth also mentioned Trikatu for ‘Pratisarana’ in Mukhroga Chikitsa. Mukh Daurgandhya is not mentioned as separate disease but it is seen as a symptom of some disease.[2]

Chaturjata is used as Prakshepa Dravyas in various Kalapana to give them good taste, pleasant flavor and to augment appetite. Because of aromatic or Sugandhi, they give pleasure to the mind. They act as mouth fresheners.

Chaturjaat have the properties of Rochan, Ruksha, Tikshna, Ushna, Mukhgandhhar, Laghu, Agni Vardhak, Varnya and pacify Kapha, Vaat, Visha.[3]

Chaturjaat is used as Hima and the reason behind this is, Chaturjaat contains medicines which have aromatic properties in it. Aromatic properties fade away once they are boiled with water so it is better to use Hima instead of Kwath of Chaturjaat.

In childhood and old age, Kavala is frequently chosen over Vaya or Avastha Anusasra. Because correct tone of the muscles of the oral cavity is not achieved in children, the act of Kavala must be performed to strengthen them. Due to degenerative processes, muscles become flaccid and lose their tonicity as people age. As a result, Kavala is suggested.[4]

Procedure Review

Definition[5]

  • The material used moves easily in the mouth is Kawala.
  • Medicated fluids are kept in the mouth incompletely and asked to rotate in the mouth for a specific time and then asked to spit it out.
  • As per Sarangadhara, Kalka (medicated bolus) drugs are used in Kawala and liquids are used in Gandusha.

Dharana Kala (duration): Gandusha and Kawala should be used after the age of 5 year. These can be used three, five, seven times or till balancing of Doshas.

Effects of the Procedures[6]

Samyak Yoga Lakshana (proper effects)

  • Vyadherpachaya (palliation of diseases or illness),
  • Tushti/ Santosh (freshness of oral cavity),
  • Vaishadhyam /Nirmalta (cleaning of mouth),
  • Vaktralaghavam(lightness of mouth),
  • Indriyanam Prasada (sense organs tend to their work)



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Rajpurohit R et al: Chaturjaat Kawala in the management of Mukh Daurgandhya

Heena Yoga Lakshana (inadequate effects)

  • Kaphotklesh (excessive salivation),
  • Rasaagyana (improper functioning of taste buds),
  • Aruchi (anorexia),
  • Jadata (stiffness)

Atiyoga Lakshana (excessive effects)

  • Mukha Paka (mouthulcers),
  • Mukha Shosha (dryness of mouth),
  • Trishna (thirst),
  • Klama (feeling of exhaustion)

Benefits of Gandusha and Kawala

It strengthens the jaw and improves quality of voice & muscle mass, clears the tongue so that appetite and sense of taste improves, prevents dryness of throat and prevents chapped lips. It strengthens the teeth and gums & also prevents sensitivity of teeth. It also seen effective in diseases like spondylitis, headache, maintaining the eyesight, dryness of mouth and rhinitis and many more supra clavicular diseases.

Hima[7]
Chaturjaat is used as Hima and the reason behind this is, Chaturjaat contains medicines which have aromatic properties in it. Aromatic properties fade away once they are boiled with water so it is better to use Hima instead of Kwath of Chaturjaat.

Hima (Cold Infusion): The raw drug is crushed or powdered coarsely (in quantity of 1 Pala = 48gm) is mixed and soaked (in quantity of 6 Pala = 288gm) in water for whole night. In morning it is filtered and this medicated liquid is collected which is called as Hima (cold infusion).

Hima Kashaya is, thus, prepared in cold water (while Phanta is made in hot water). As general proportion, powdered drug 24gms is soaked in 144ml water and retained for a night. Lastly, the liquid is strained in morning, e.g., Dhanyaka Hima.

Drug Review[8]
Chaturjaat and its Mukhgandh Har property is mentioned in ‘Karpuradi Varg’ of Bhavprakash Nighantu.

Chaturjaat have the properties of Rochan, Ruksha, Tikshna, Ushna, Mukhgandhhar, Laghu, Agni Vardhak, Varnya and pacify Kapha, Vaat, Visha.

[9]

All the four herbs; stem bark of Twak, fruit and seeds of Ela, leaves of Tejapatra and stamen of Nagkeshar were taken in equal quantity and powdered together.

SN Sanskrit name Latin name Family Vishishta Karma Doshahar karma Rogaghan-ata
1 Tavaka Cinnamomum zeylanicum Lauraceae Sangrahi Vatakapha Shamaka Pinasa, Kasa
2 Ela Eletarria cardamomum Zinziberacea Rochana Pachana Tridosha Hara Kasa, Shwasa
3 Teja patra Cinnamomum tamala Lauraceae Sangrahi Vatakapha Shamaka Pinasa, Kasa
4 Nagkeshar Mesua ferrea Guttiferae Rakta Stambhan Kaphapitt Shamaka Raktarsh

Result of Antimicrobial study

SN Microbial Strains Standard (Positive control) Chaturjaat Churna DMSO (Negative control)
5mg/ml 10mg/ml
1 Porphyromonas gingivalis 24 24 26 8
2 Prevotella intermedia 30 24 28 8

Materials and Methods

Materials and methods required to conduct the trial are as under:

Literary: For literary analysis various Ayurvedic Classical Texts and modern medical texts have been referred to study Mukhdaurgandhya and Halitosis respectively.

Clinical: It includes the investigations, observation of cases and trial procedures.

Study Design

Type of Study: Clinical trial was randomized. In therapeutically trial, important components are the Cases, the parameters for evaluation of results and the treatment.

Type of trial Methodology

It was an open trial.

Sources of Data: Cases suffering from Mukhdaurgandhya (Halitosis) who were fulfilling the inclusion and diagnostic criteria were chose from the O.P.D & I.P.D of Hospital of University Post Graduate Institute of Ayurveda Studies and Research, Jodhpur. 60 cases were registered in total for current trial. Out of which no cases dropped out.


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The cases chosen for the research work were briefed about the nature of the trial, its positive and negative impact was also explained. Their consent was also obtained before trial.

Selection of Cases

  • The study will be done on 60 volunteers in two groups and each group of 30 volunteers.
  • Volunteers fulfilling the criteria for selection will be enrolled into the study irrespective of their gender, cast, religion etc.
  • A specially designed proforma will be prepared and informed consent will be taken from the volunteer before trial.
  • One group will be given 'Chaturjaat Kawala' and the other group will use warm water for gargling.

Inclusion Criteria

  • Cases between the age of 13-19 years.
  • Both male and female candidates are included.
  • Candidates with the complaint of foul breath or halitosis.
  • Candidates with the complaint of Asya Vairasya (tastelessness) due to oral unhygienic condition.
  • Candidates with the complaint of less Annabhiruchi (desire of food) due to oral unhygienic condition.
  • Candidates with the complaint of Uplepa (feeling of coating in the mouth).

Exclusion Criteria

  • Patients less than age of 13 years and more than 19 years.
  • Patients of oral cancer.
  • Patients of Leucoplakia.
  • Patients of oral chronic diseases.

Subjective Parameters

  • Mukh daurgandhya (foulness of breath)/halitosis
  • Asya vairasyata (tastelessness)
  • Sensitivity of teeth
  • Saumanasya (pleasentness/freshness)
  • Annabhiruchi (desire of food)
  • Uplepa (feeling of coating in the mouth)
  • pH of Saliva

Withdrawal Criteria

  • If case wants to withdraw from clinical trial.
  • During the course of the trial, if any serious conditions occur or any serious adverse effect is seen which requires emergency treatment.
  • Non-compliance of Cases.
  • During the course of treatment if volunteer gets pregnant.

Antimicrobial study

Antimicrobial study of Chaturjaat Churna

Criteria of Assessment

Subjective parameters were put in use for the assessment the effect of the treatment.

Subjective Criteria includes

  • Mukh Daurgandhya (foulness of breath)/halitosis
  • Asya Vairasyata (tastelessness)
  • Sensitivity of teeth
  • Saumanasya (pleasentness/freshness)
  • Annabhiruchi (desire of food)
  • Uplepa (feeling of coating in the mouth)
  • pH of saliva

Based on the grading score, improvement in signs and symptoms were assessed.

Plan of Study

Cases without any discrimination based on sex, religion, caste, age etc are randomly distributed into 2 groups.

Group A - 30 Trial cases were treated with Chaturjaat Kawala.

Group B - 30 Trial cases were treated with Lukewarm water Kawala.

Table - Classification of cases in groups.

Group Detail of group No. of registered cases Cases completing the trial Duration of trial
A Chaturjaat Kawala 30 30 30 days
B Lukewarm water 30 30 30 days
Total no. cases and trial duration 60 60 30 days for each group



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Drug administration Schedule with Dosage and Timings

Drug Dose Duration Sevan Kala
1.Chaturjat Kawala (Hima)   Every morning use 20 ml drug 3 times repeatedly, Total 60 ml. 30 to 40 seconds for one time, total 3 times every morning repeatedly for 30 days.   Morning
2. Lukewarm water Every morning use 20 ml drug 3 times repeatedly, Total 60 ml. 30 to 40 seconds for one time, total 3 times every morning repeatedly for 30 days. Morning

Observations

Overall assessment of effect of the therapy on both the groups

Assessment criteria Group - A Group - B
No. of Patients % No. of Patients %
Complete remission 0 0 % 0 0 %
Marked improvement 0 0 % 0 0 %
Moderate improvement 1 3.33 % 0 0 %
Mild improvement 18 60 % 5 16.66 %
Unchanged 11 36.66% 25 83.33%

In group-A: 0% was found complete remission, 0% were found marked improvement, 3.33% were found moderate improvement, 60% were found mild improvement and 36.66% was found unchanged.

In group-B: 0% was found complete remission, 0% were found marked improvement, 0% were found moderate improvement, 16.66% were found mild improvement and 83.33% was found unchanged.

jaims_2166_01.JPG

% Improvement of Subjective Parameters in Both Groups

SN Parameters Result in percentage
Group A Group B
1. Mukh Daurgandhya (foulness of breath) 46.37 17.46
2. Aasya Vairasyata (tastelessness) 37.5 23.25
3. Saumanasya (pleasantness/ freshness) 26.08 13.95
4. Annabhilasha (desire of food) 23.80 17.27
5. Uplepa (coating of mouth) 28 26.82
6. Sensitivity of tooth 25 15.38
7. pH of Saliva 28.57 18.91
Average % of Relief 30.76 % 19.005 %

The improvement in Oral hygiene and Mukh Daurgandhya were found to the maximum in Group-A (30.76%), followed by Group-B (19%). These results prove that the Group-A i.e., Chaturjaat Kawala is more effective in oral hygiene and Mukhdaurgandhya than the Group-B i.e., Lukewarm water Kawala.

Results

Comparative effect of therapy on Subjective Parameters

To assess the comparative effect of both the therapy, Mann-Whitney test was applied on data using GraphPad Instat Software which is shown in above table and their interpretations are stated below.

Overall Effect of the therapy on subjective symptoms of oral Hygiene

Subjective Parameters Mean score % Relief U P S
Group A Group B Group A Group B
Mukh Daurgandhya 1.06 0.36 46.37 17.46 192 <0.0001 ES
Aasya Vairasyata 0.64 0.35 37.50 23.25 280 0.0316 S
Saumanasya 0.44 0.23 26.08 13.95 276 0.0872 NS
Annabhilasha 0.35 0.33 23.80 18.91 287 0.4467 NS
Uplepa 0.5 0.44 28.0 26.82 322 0.3091 NS
Sensitivity of tooth 0.46 0.26 25 15.38 239 0.1115 NS
PH of Saliva 0.34 0.29 28.57 18.91 260 0.3715 NS

*n- no. of samples, B.T.- Before Treatment, A.T.- After Treatment, Diff- difference between the value of B.T. and A.T, U-Mann Whitney constant, ‘P’ value -Probability of Observations S-significance of obtained p-value

To assess the comparative effect of both the therapy, Mann-Whitney test was applied on data using GraphPad Instat Software which is shown in above table and their interpretations are stated below.

Mukh Daurgandhya (foulness of breath): On comparing the effect of both therapy on Mukh Daurgandhya obtained p value is <0.0001 i.e., extremely-significant difference statistically. Percentage wise Group A (46.37%) showed better relief then Group B (17.46%).



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Aasya Vairasyata (tastelessness): On comparing the effect of both therapy on Aasya vairasyata obtained p value is 0.0316 i.e., significant difference statistically. Percentage wise Group A (37.50%) showed better relief then Group B (23.25%).

Saumanasya (pleasantness): On comparing the effect of both therapy on Saumanasya obtained p value is 0.0872 i.e., non-significant difference statistically. Percentage wise Group A (26.08%) showed better relief then Group B (13.95%).

Annabhilasha (desire of food): On comparing the effect of both therapy on Annabhilasha obtained p value is 0.4467 i.e., non-significant difference statistically. Percentage wise Group A (23.80%) showed better relief then Group B (18.91%).

Uplepa (tastelessness): On comparing the effect of both therapy on Uplepa obtained p value is 0.3091 i.e., non-significant difference statistically. Percentage wise Group A (28.0%) showed better relief then Group B (26.82%).

Sensitivity of tooth: On comparing the effect of both therapy on Sensitivity of tooth obtained p value is 0.1115 i.e., non-significant difference statistically. Percentage wise Group A (25%) showed better relief then Group B (15.38%).

PH of Saliva: On comparing the effect of both therapy on PH of Saliva obtained p value is 0.3715 i.e., non-significant difference statistically. Percentage wise Group A (28.57%) showed better relief then Group B (18.91%).

Conclusion

Prevalence of Mukhdaurgandhya in teen agers is increasing because of changed unhealthy eating habits of junk food and cold drinks. Excessive stress induced by pressure of competitive studies resulting into skipping of regular practice of oral hygienic procedures. Anti-microbial Susceptibility showed against both bacteria Porphyromonas gingivalis, Prevotella intermedia in Chaturjaat sample. The cost effective, simple, yet effective treatment of Chaturjaat Kawala could easily be employed by patient for a longer run. Kawala procedure also helps in boosting the oral cavity wellbeing by providing a nourishment to oral cavity and strengthens buccal muscles. Vihara (confined to Nidra) wise distribution shows higher incidence who had history of Ratri Jagarana due

to some cause. It can be assumed that persons during Ratri Jagarana will have irregular food habits, no adequate sleep and rest and more stress, which is main cause for oral problem. Divaswapna is also considered as one of the cause of Kapha Pitta Prakopaka which is responsible for oral problem. The clinical study revealed that the use of Chaturjaat Kawala showed more efficient results than Lukewarm water in improving Mukhdaurgandhya, Saumansyata, Anannabhilasha, Uplepa, Sensitivity and pH. In Anti-microbial study, almost same zone of inhibition found as compare to standard drug. It is presumed that quiet effective anti-microbial activity was reported. No adverse and side effect of the trial drugs were observed during the study.

Reference

1. Bhavmishra, Bhav Prakash, Varanasi; Chokhambha Prakashan,2011; part 1, 5/24-44

2. Aacharya Susruta, Susruta Samhita, niimh.nic.in/e-books; Chikitsa Sthan 40/62, Aacharya Vagbhatta, Ashtang Hridaya, niimh.nic.in/e-books; Sutra Sthan 22/10

3. Bhavmishra, Bhav Prakash, Varanasi; Chokhambha prakashan,2011; part 1, 5/24-44

4. Dr. Shailja Srivastava, Sharangdhar Samhita, Varanasi; Chokhambha Orientalia,2009; Uttarkhanda 10/4

5. Dr. Shailja Srivastava, Sharangdhar Samhita, Varanasi;Chokhambha Orientalia,2009; Uttarkhanda 10/5-6

6. Dr. Shailja Srivastava, Sharangdhar Samhita, Varanasi; Chokhambha Orientalia,2009; Uttarkhanda 10/7

7. Aacharya Siddhinandan Mishra, Yogaratnakar, Varanasi; Chokhambha Orientalia,2005; 5 Khanda.

8. Bhavmishra, Bhav Prakash, Varanasi;Chokhambha prakashan,2011; Karpuradi Varga 72-73

9. Chem. Pharm. Bull. 1981, 29, 2686, A text book of Dravyaguna Vignyana., API e book, Part-1, page 136,137


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