E-ISSN:2456-3110

Research Article

Extrinsic dental stain

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 3 March
Publisherwww.maharshicharaka.in

Assessment of efficacy of Kankshi Bhasma Dhantadhavana in extrinsic dental stain an observational study

Turamari M1*, Tigale K2
DOI:10.21760/jaims.9.3.7

1* Manjula Turamari, Assistant Professor, SNVV’S SGV Ayurvedic Medical College Hospital and Research Centre, Bailhongal, Karnataka, India.

2 Kshitija Tigale, Fourth Year BAMS Student, SNVV’S SGV Ayurvedic Medical College Hospital and Research Centre, Bailhongal, Karnataka, India.

Chewing tobacco and use of SLT (smokeless tobacco) products cause considerable staining of teeth among users. Discolouration of the teeth is a common complication of tobacco chewing. The stains bind and penetrate the enamel, dentin, root surfaces causing a brown to black discolouration. Tobacco stains cause the enamel to wear away over time. This exposes the dentin (a softer layer of teeth underneath the enamel), which starts to show through, teeth will look increasingly more yellow. These stains can also lead to gum diseases. Artificial dentures, prosthesis is also discoloured by prolonged tobacco chewing. The coarse abrasives in tobacco products when constantly chewed cause abrasion or tooth wear. Chewing tobacco also increases the incidence of dental caries and thereby causes tooth loss. Epidemiology suggests tobacco users have 67 per cent tooth loss compared to non-users. The high content of sweetening and flavouring agents in tobacco products is responsible for tooth decay. To overcome this Kankshi Bhasma Dantadhavan can be an efficient way Kankshi (Potash alum [K2SO4, Al2(SO4)3.24H2O] having antiseptic and antibacterial properties along with that Vruna Ropana, Lekhana, Mukha Rogahara, Dantadadryakara. Danta Paichilyahara, Dantasharkarahara Karma. It is the high time to intervene Ayurveda as remedy in dental stains specific to tobacco chewing.

Keywords: Dental stain, Kankshi Bhasma, Dantadhavan, Dantasharkarahara

Corresponding Author How to Cite this Article To Browse
Manjula Turamari, Assistant Professor, , SNVV’S SGV Ayurvedic Medical College Hospital and Research Centre, Bailhongal, Karnataka, India.
Email: 		Turamari M, Tigale K, Assessment of efficacy of Kankshi Bhasma Dhantadhavana in extrinsic dental stain an observational study. J Ayu Int Med Sci. 2024;9(3):48-53.
Available From
https://jaims.in/jaims/article/view/3163

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-01-14 2024-01-24 2024-02-03 2024-02-13 2024-02-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.87

© 2024by Turamari M, Tigale Kand 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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Manjula Turamari et al. Efficacy of Kankshi Bhasma Dhantadhavana in dental stain

Introduction

What can be something that is attractive in a person? Yes, it can be smile and the talk. Wherein, in the world of interaction and communication the oral hygiene is of great impact. Oral cavity being the portal for GIT entrance affects quality of life depending on individual life style. Hence oral unhygienic can be major turn off in society and disturbing appearance too.

Irrespective of socio-economic conditions, sex, illiteracy, occupation and age, people have habituated tobacco consumption on daily basis by many means like chewing, smoking etc. India is second highest consumer of tobacco, has one of the highest rates of tobacco related morbidity and mortality in the world. 25.9% of adults use tobacco, including 32.9% of males and 18.4% of females.

Habits like, Gutaka/tobacco chewing, drinking tea and coffee leads to many oral aliments including oral cancer, fibrosis, loss of periodontal support and dental staining. Stain on teeth are of two types, extrinsic and intrinsic. Extrinsic stain is superficial type of discoloration that affects enamel. Intrinsic stain doesn’t have any treatment in modern science and for extrinsic stains will not respond to regular brushing as these stains are deeply situated, and only management way is professional scaling and polishing or else aesthetic correction (veneers, crowns).

To overcome this entire cosmetic including oral health issues it’s better to go for Ayurvedic management by Kankshi Bhasma. Kankshi (Potash alum) having antiseptic and antibacterial properties along with Vruna Ropana, Lekhana, Mukha Rogahara, Dantadadryakara, Danta Paichilyahara, Dantasharkarahara Karma. It is the high time to intervene Ayurveda as remedy in dental stains specific to tobacco chewing.

Aims and Objectives

1. To study in detail about the Kankshi Bhasma.
2. To study about Dental stain.
3. To know the effect of Kankshi Bhasma on tooth staining due to tobacco chewing.

Materials and Methods

Type of study: Observational study

Drug source

1. Collection of Kankshi from GMP certified pharmacy.
2. Preparation of Kankshi Bhasma.

Clinical source

The patients attending OPD/IPD of SNVV'S, SGV Ayurvedic college, Hospital and Research Centre, Dental Department.

Method of collection of data

It's a single blind clinical study, patients of dental stain selected are included in a single group, and the results are recorded as per the proforma designed for the study.

Parameters of signs and symptoms were scored on the basis of standard method of grading. The obtained data was subjected to suitable statistical analysis.

Selection of patients

Sample size - 15
Duration of study - 30 days.

Inclusion criteria

1. Age group of 20-60 years.
2. The signs and symptoms of extrinsic dental stain, which is manifested due to gutaka/tobacco chewing are taken for study.

Exclusion criteria

1. Patient with age group below 20 year and above 60 years.
2. The patient suffering from any other systemic illness like cancer, Tuberculosis, Herpes simplex, cardiac disease, HIV etc.

Administration of drug

  • Dose as required quantity of individual patients
  • Duration and Time: Kankshi Bhasma is given for Danta Dhavana (rubbing with fingers for 2 minutes) early morning and before bed.

Grading for assessing parameters

  • Grade 0 - Stains absent
  • Grade 1 - stains involving only proximal surface without involving labial or lingual surface
  • Grade 2 - stains covering up to

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Manjula Turamari et al. Efficacy of Kankshi Bhasma Dhantadhavana in dental stain
  • half of the labial or lingual crown surface, with or without involvement of proximal surface.
  • Grade 3 - stain covering more than half of labial or lingual crown surface, with or without involvement of proximal surface.

Result

The clinical trial was conducted on 15 patients of tobacco stain fulfilling the inclusive criteria. The patients were randomly selected. The subjective and objective parameters of patients were noted before the treatment and after treatment, for statistical analysis Wilcoxon matched pairs test was applied to all the parameters. The results of Kankshi Bhasma over tobacco stains are presented here.

1. Effect of Kankshi Bhasma on stains

The above table shows the effect of use of Kankshi Bhasma Dantadhavan in Grade 1, 2 and 3 respectively, the patients having extrinsic stains with grade 1 had an improvement, which reduced to grade 0 and grade 2 reduced to grade 1, significant improvement was observed in these patients.

There is no significant improvement in grade 3.

The mean score of patients before treatment was 2.2 and it reduced to 1.1 after treatment, showing overall improvement of 48.8% on overall study.

The reduction of staining in patients with grade 1 and grade 2 was significant.

2. Status of frequency of tobacco chewing

The above table (1.1 and 1.2) shows status of frequency of tobacco chewing before and after treatment.

The mean score before the treatment was 3.0 and it reduced to 2.0 after treatment. The significant improvement in reduction of stain was seen in the patients with reduced frequency of tobacco chewing as compared with those continued it.

3. Status of quantity of tobacco and gutka chewing

Quantity of tobacco chewing in patients was reduced by 25% and those in gutka chewing was reduced by 37.93 %.

The mean score of tobacco chewing patients before treatment was 3.3 and that of gutka chewing patients was 3.2 which reduced to 2.5 and 2.0 respectively in both the groups.

4. Status of Gingivitis

Gingivitis was reduced by 100%, the mean score before treatment was 1.0 which reduced to 0 after treatment. It shows significant improvement in gingivitis.

Table 1: Comparison of before and after treatment with grades of Tobacco staining

Tobacco stainingBefore treatment%After treatment%
Grade 000.00213.33
Grade 1213.33960.00
Grade 2853.33426.67
Grade 3533.3300.00
Total15100.0015100.00

Table 2: Comparison of before and after treatment with grades of Tobacco staining by Wilcoxon matched pairs test.

TreatmentMeanMedianIQR% of changeZ-valuep-value
Before treatment2.22.01.0
After treatment1.11.01.048.483.40780.0007*

*p<0.05

Figure 1: Comparison of before and after treatment with grades of Tobacco staining
jaims_3163_01.JPG

Table 3: Comparison of before and after treatment with status of Frequency of tobacco chewing / Day

Frequency of tobacco chewingBefore treatment%After treatment%
1 to 5 times213.33426.67
6 to 10 times320.00640.00
11 to 15 times320.00426.67
16 to 20 times746.6716.67
Total15100.0015100.00

Table 4: Comparison of before and after treatment with status Frequency of tobacco chewing /Day by Wilcoxon matched pairs test.

TreatmentMeanMedianIQR% of changeZ-valuep-value
Before treatment3.03.02.0
After treatment2.12.02.028.892.80310.0051*

*p<0.05


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Manjula Turamari et al. Efficacy of Kankshi Bhasma Dhantadhavana in dental stain

Figure 2: Comparison of before and after treatment with status of Frequency of tobacco chewing /Day
jaims_3163_02.JPG

Table 5: Comparison of before and after treatment with Quantity of Tobacco chewing.

Frequency of tobacco chewingBefore treatment%After treatment%
1 to 5 gm00.00116.67
6 to 10 gm116.67233.33
11 to 15 gm233.33233.33
16 to 20 gm350.00116.67
Total6100.006100.00

Table 6: Comparison of before and after treatment with status Quantity of Tobacco chewing by Wilcoxon matched pairs test.

TreatmentMeanMedianIQR% of changeZ-valuep-value
Before treatment3.33.51.0
After treatment2.52.51.025.001.82570.0679**

*p<0.10

Table 7: Comparison of before and after treatment with Quantity of Gutka chewing.

Frequency of tobacco chewingBefore treatment%After treatment%
1 to 5 Packets111.11333.33
6 to 10 Packets111.11444.44
11 to 15 Packets222.22111.11
16 to 20 Packets555.56111.11
Total9100.009100.00

Table 8: Comparison of before and after treatment with status Quantity of Gutka chewing by Wilcoxon matched pairs test

TreatmentMeanMedianIQR% of changeZ-valuep-value
Before treatment3.24.01.0
After treatment2.02.01.037.932.36640.0180*

*p<0.05

Figure 3: Comparison of before and after treatment with Quantity of Tobacco chewing
jaims_3163_03.JPG

Figure 4: Comparison of before and after treatment with Quantity of Gutka chewing
jaims_3163_04.JPG

Table 9: Comparison of before and after treatment with status of gingivitis.

Status of gingivitisBefore treatment%After treatment%
Present10100.0000.00
Cured00.0010100.00
Total10100.0015100.00

Table 10: Comparison of before and after treatment with status Quantity of Gutka chewing by Wilcoxon matched pairs test.

TreatmentMeanMedianIQR% of changeZ-valuep-value
Before treatment1.01.00.0
After treatment0.00.00.0100.002.80310.0051*

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Manjula Turamari et al. Efficacy of Kankshi Bhasma Dhantadhavana in dental stain

*p<0.05

Figure 5: Comparison of before and after treatment with status of gingivitis
jaims_3163_05.JPG

Discussion

The intervention of Kankshi Bhasma is done in 15 patients and it’s found highly significant in Grade 1 and 2 patients.

Since the Wilcoxon matched pair test is statistically highly significant, Hence Kankshi Bhasma Danta Dhavan is found to be highly significant in Extrinsic dental stain.

Owing to the Paichilyahara and Dantasharkarahara, Vaishadyakara properties and due to Kashaya Rasa of Kankshi, its proven to be effective against the tobacco dental stain.

The anti- inflammatory property proved to be 100 % efficient against gingivitis and stomatitis.

The hemostatic (Shonitasthapana) and Ropana property of Kankshi proved efficient in the bleeding gums and mouth ulcers.

It also showed significant changes in the reduction in the desire for tobacco chewing, as owing to its detoxifying properties, extremely beneficial in purifying the blood, which improves blood circulation and helps remove toxins from the body.

Its antimicrobial property inhibits the growth of gram positive and gram negative bacteria which also shown significant in the patients with toothache due to underlying cause of dental caries.

The anticarcinogenic property of Kankshi Bhasma is effective against the mouth cancer.

Oral mucosal fibrosis (OSMF) characterised by severely limited mouth opening, blanching of oral mucosa and burning sensation in oral cavity was found in one of the patients was significantly improved after the use of Kankshi Bhasma for Dantadhavan.

Conclusion

The findings of this study conclude that Kankshi Bhasma Dantadhavan can produce significant changes in Grade 1 and Grade 2 stain and has shown a combined effect over gingivitis, bleeding gums, and overall oral cavity hygiene. The drug is easily available, easy to administer, easy to store, the time period of the study was short, yet proved significant in the extrinsic stain.

Acknowledgement

This study was carried out with the Financial Support and sponsorship from Advanced Research and Development Department of Rajiv Gandhi University of Health Sciences, Karnataka, Bengaluru. The authors would like to thank for their support.

References

1. Ravindra Angadi, A Textbook of Rasashastra, Chaukhamba Surbharati Prakashan, Varanasi

2. Ravindra Angadi, Rasa Tarangini, Chaukhamba Surbharati Prakashan, Varanasi, First Edition: 2015, Pg. no. 182-184.

3. Siddhinandan Mishra, Rasendra Chudamani, “Siddhiprada”- Hindi vyakhyan sahita, Chaukhamba Orientalia, Varanasi, Edition: Reprint 2017, Pg. no. 179-181, shloka no. 49-53.

4. Bhudev Mukherji. Rasa Jala Nidhi, Shri Gokul Mudranalaya, Varanasi, Second Edition: Reprint 1984, Pg. no. 152-154

5. Rasa Yoga Sagar Vol I&II with Sanskrit and English introduction by Vd. Pandit Hariprapannaji, Krishnadas Academy, Varanasi, Edition: Reprint, Pg. no. 419, shloka no. 114-130

6. Damodar Joshi and G. Prabhakara Rao, Rasamritam, Chaukhamba Sanskrit Sansthan, Varanasi, Edition: Reprint 2007, Pg. no. 141-142.

7. Acharya Sadananda Sharma,


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Manjula Turamari et al. Efficacy of Kankshi Bhasma Dhantadhavana in dental stain

Rasatarangini Motilal banarsi das production Ekadasha Taranga shloka 177- 207.

8. Rasendra Chudamani, Rameshwar dayal Bajpai, Chowkhamba Krishnadas Academy 11th chapter shloka 45-49, of no 139, 140.

9. Rasaratna Samucchaya, Ambikadatta Shastri, Chowkhamba Amarbharti Prakashan, varanasi, chapter 3 shloka 62-69, pg no 72-73

10. Indradeo Tripathi, Rasarnavam. Chowkhamba sanskrit series, Varanasi, saptamapatala pg no 99.

11. Sushruta Samhita, Ambikadatta Shastri Chowkhamba sanskrit samstha, Adhyay 22 shloka no 37, Adhyay 16 shloka 34.

12. Yogaratnakar “vidyotini “Hindi Teeka, Vaidya Shreelaxmipati Shastri, Chowkhamba Prakashan,Reprinted 2018, pg no 366.

13. http://www.iamj.in/current_issue/images/upload/2900_2904.pdf

14. https://www.easyayurveda.com/2022/10/14/sphatika-alum/

15. https://m.netmeds.com/health-library/post/sphatika-bhasma-benefits-ingredients-method-dosage-and-side-effects

16. https://www.ayurmedinfo.com/2012/07/26/sphatika-bhasma-benefits-dosage-ingredients-side-effects/

17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9932248/

18. https://eberhardtdentistry.com/uncategorized/how-to-remove-tobacco-stains-on-teeth-instantly/

19. https://onlinelibrary.wiley.com/doi/full/10.1002/cre2.683

20. https://pubmed.ncbi.nlm.nih.gov/36372903/

21. https://www.healthline.com/health/how-to-remove-nicotine-stains-from-teeth

22. https://www.smilebrilliant.com/articles/tobacco-stains-on-teeth/

23. https://www.dental-tribune.com/news/study-evaluates-staining-properties-of-tobacco-products/.


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