“Swasthyavrit: Circle of Health”

In continuation of this series on “Swasthyavrit,” we are going to take a look at what the ancient wisdom of Ayurveda has to offer for oral health.

Just like any body system or organ, Ayurveda has its individualistic approach in looking at the health of the mouth. This is further defined by each individual’s constitution (Prakriti) and current environmental influences (weather, relationships, mental/emotional state, diet, and lifestyle) that make up an individual’s current state of imbalance (Vikriti).

Each dosha withholds characteristics that help define the various “oral types.” These qualities further predetermine what potential “problems” one may experience in his/her mouth.

	Vata Dominant / Imbalance (ether & air)	Pitta Dominant / Imbalance (fire & water)	Kapha Dominant / Imbalance (earth & water)
Characteristics	Dry, rough, cracked, thin, receding gums, tooth pain, cavities	Sensitive, prone to redness, itchy, ulcers, bleeding gums, allergies	Mucus (can be thick), dental plaque & tarter, thick white coating on tongue

Healthy Nutrients for Oral Health:

As Benjamin Franklin mentioned, “One should eat to live, not live to eat,” it is essential to recognize what we are putting into our mouth and how that is affecting our health. In this case, let’s consider what nutrients impact the health of the mouth. Key nutrients are outlined below.

Water Soluble Vitamins for Oral Health^[1]

	Function in the Mouth	Source	Deficiency Symptoms
Vitamin C- Ascorbic Acid	Clotting Collagen production Antioxidant Helps calcium and iron absorption	Citrus fruit (orange, grapefruit) Kiwi Strawberries Red pepper Cantaloupe Potato Spinach Green peas Cruciferous vegetables (broccoli, cauliflower, brussels sprouts, cabbage) Tomatoes Leafy greens[2]	Scurvy Capillary fragility Slow healing Easy to bleed
B1- Thiamine	Produce energy, new cells	Meat, organs Whole grains Yeast Rice Trout Black beans Mussels Tuna[3]	Burning mouth (symptom in a condition known as Beriberi)
B2- Riboflavin	Produce energy, new cells	Milk products (milk, yogurt, cheese) Meat, poultry (beef liver) Oats Clams Portabella Almonds Fish Whole grains[4]	Ariboflavinosis: angular cheliosis, glossitis
B6-Pyridoxine	Metabolize carbohydrates, fats, proteins	Fish (Salmon, Tuna) Chicken breast Chickpeas Beef Liver Potatoes[5]	Glossitis
Biotin	Structure and support- collagen	Egg yolk Liver Soy flour Lentils Nuts Yeast[6]	Pallor of tongue Atrophy of structures

Fat Soluble Vitamins for Oral Health^[1]

	Function in the Mouth	Source	Deficiency Symptoms
Vitamin A & Beta Carotene	Protect from infection Maintains health Antioxidant Forms the layers of the mouth Increase immunity Wound healing	Yellow/orange fruits and vegetables: Sweet potato, beef liver, spinach, carrot, cantaloupe, sweet pepper, mango, black-eyed peas, apricot, broccoli, ricotta cheese, tomato juice, Atlantic Herring, beans Eggs Chicken breast Squash Salmon, tuna Yogurt[7]	Atrophy of mouth tissue Oral leukoplakia
Vitamin D	Helps absorb and deposit calcium & phosphorus in the teeth and bones Build bone and teeth	Sun exposure Skin fat flesh of salmon, tuna, and mackerel Fish liver oil Beef liver, cheese, and egg yolks[8]	Delay in tooth development/eruption Decrease in calcification in enamel
Vitamin K	Used in formation of clotting	Intestinal microflora Natto Leafy greens (collard, turnip greens, kale, spinach) Broccoli Soybeans Carrot juice Edamame Pumpkin Pomegranate juice Okra Pine nuts Cashews Mixed nuts Blueberries Grapes Figs Iceberg lettuce Chicken breast Liver[9]	Failure to stop bleeding

Minerals for Oral Health^[1]

	Function in the Mouth	Source	Deficiency Symptoms
Calcium	99% stored in teeth and bones	Dairy (cottage cheese, milk, cheddar cheese, yogurt) Broccoli Turnip greens Kale Bok choy Sardines Salmon Nuts[10]	Incomplete calcification of teeth Prone to cavities Increase in tooth movement
Phosphorus	80-90% in bones and teeth Formation of bone and teeth	Dairy Goat milk Poultry Fish (salmon, halibut, cod, trout, tuna) Whole grains Portabella Mushroom Edamame Potato with skin Nuts and seeds (pumpkin, Brazil, almond, pine nuts, cashew, pistachio) Tahini Legumes and beans[11]	Demineralization of bone, loss of calcium Incomplete calcification of teeth Prone to cavities Periodontal disease
Fluorine	Stored in teeth and bones	Tea, gelatin, seafood, fluoridated water[12]	Prone to cavities Weak bones and teeth
Magnesium	60% in bones and teeth	Green leafy veggies (spinach) Broccoli Nuts (almond, cashew, peanuts) Soymilk Kidney/black beans Edamame Carrot Avocado Brown rice Potato with skin Yogurt Banana Apple Salmon Halibut Chicken breast Beef Whole grains[13]	Hypertrophy of gum tissue
Iron	20% stored in bone marrow Carry oxygen to cells Collagen formation Wound healing	Red meat (beef), chicken liver, clams, mollusks, mussels, oysters, sardines, turkey, salmon, halibut, tuna, veal, beans/lentils, spinach, pumpkin seeds, sesame seeds, squash seeds, potato, broccoli, nuts, Nettles	Angular cheliosis, pallor of lips and mouth tissue, glossitis, candidiasis, dysphagia
Zinc	Normal growth, development, taste and smell receptors Collagen formation Wound healing	Oysters, beef, crab, lobster, liver, pork, chicken, yogurt, cashews, cheese, oatmeal, milk, almonds, beans, peas, flounder, sole, nuts and seeds[14]	Loss of taste and smell Delayed wound healing Candida Periodontal disease Cavities

To note: most all nutrients that have been highlighted above are and can be sufficiently consumed by food alone. Before the advent of synthetic vitamins and supplements, the human species relied heavily on nutrition from food. Although a primitive thought, we are still primitive beings that prosper with consuming natural products so the body can utilize such products as it needs.

Some Tips:

• Crunchy, fibrous vegetables and fruits increase salivary flow, which helps provide antibacterial effects. Other food sources that stimulate salivary flow include: cool, sour, and tart nutrient dense foods.^[1]
• All simple sugars are potentially cariogenic (cavity causing). These include: refined sugar products, candy, cookies, cakes, pastries, corn syrup soda, juice, and chips.^[1]
• A lukewarm water swish in the mouth after meals may help rinse and prevent food from sticking to or in between the teeth. In Ayurveda, this is a routine practice and is known as water pulling (gandusha).

Oral Care and Cleansing:

Oil Pulling (Kavala Gandusha/Graha)

Newer to the Western world, oil pulling has been touted in Ayurveda as a practice that cures over 30 systemic illnesses, including headaches, hypertension, diabetes, and asthma. Oil pulling also helps prevent bad breath, decay, bleeding gums, dry mouth/throat, loss of taste, cracked lips, strengthens teeth, gums and the jaw, and purifies the entire system.^[15,16]

Recent studies have validated the use of oil pulling in oral health. Specifically, there has been significant benefit in gingival index scores, plaque index scores, and total colony count of aerobic microorganisms, including Streptococcus mutans and Lactobacillus count. The effects have been found to be comparable to the “gold standard” of chlorhexidine mouthwash.^[17,18]

The Two Methods:

In Kavala Graha, the mouth is filled in the mouth and then swished for 15-20 minutes in the morning and evening. In Kavala Gandusha, the oil is filled in the mouth and just kept closed for 15-20 minutes in the morning and evening.

Over time, the viscous oil becomes thin and white as it fills with toxins and bacteria and should be spit out. This is done in the morning when first waking, prior to using a toothbrush or chewing stick.

Oil pulling is typically done with sesame oil, which is tridoshic, coconut oil, or olive oil.

For an added benefit, powdered herbs can be added to the oil. Herbs that are specific to the oral cavity will be highlighted below.

Brushing with Chewing Sticks (Datun)

Before tooth brushes, chewing sticks of different herbal twigs were and are continued to be used to cleanse the teeth. Recent studies have validated the use of chewing sticks as being equal to and greater than the cleansing, mechanical, and gingivitis and cavity prevention effects when compared to the common toothbrush. Such herbal twigs are kashaya (astringent), katu (acrid), or tikta (bitter) in taste and quality.^{[19,20,21,22]} The basic method includes chewing the twig at one end. Generally, a fresh stick is taken from the tree of specific plants. Common plant sticks used include:

Vata dosha:

• Common to experience receding gums
• Recommend bitter-sweet or astringent tastes:
  • Licorice (Glyccrhiza glabra)
  • Black catechu or the cutch tree (Acacia catechu linn)

Pitta dosha:

• Common to have inflamed gums
• Recommend bitter taste:
  • Neem (Azadirachta indica)
  • Arjuna (Terminalia arjuna),

Kapha dosha:

• Common to have pale or hypertrophic gums
• Recommend pungent taste:
  • Fever nut (Caesalpinia bonduc)
  • Milkweed plant (Caltropis procera)

Other common herbs to use for general oral health:

• Prickly ash (Zanthoxylum americanum)
• Babul tree, or Gum accacia (Acacia arabica)
• Amla (Emblica officinalis)
  • Known to be a traditional Rasayana (rejuvenator), amla helps to rebuild and maintain tissue health.
  • Most potent source of antioxidants and vitamin C.
  • Amla supports healing, develops connective tissue, and tonifies the tissue of the oral cavity.

• Curcumin (Curcuma longa)
  • Extracted from turmeric, curcumin is a potent anti-inflammatory and anti-bacterial herb to support the health of the mouth

• Trifal
  • Known as the “three fruits,” Trifal has been used as an overall Rasayana (rejuvenator) in Ayurveda.
  • Recent studies have shown that Triphala has antibacterial properties against S. mutans bacteria, plaque and gingival index, and is as or more effective than the standard mouthwash, Chlorhexidine.^[23,24,25]

Tongue Cleaning

According to Ayurveda, parts of the tongue are related to different organ systems, such as: the lungs, the heart, the stomach, the liver, the spleen, the kidneys, thyroid, spine, and the intestines. Thus, by maintaining the health of the tongue, one can affect different organs in a positive manner. This simple procedure will remove excess coating on the tongue, prevent and remove bad breath (halitosis), remove stagnation, remove toxins, and help with functioning of the digestive system.

One does this with an empty stomach in the morning. The scraper is placed as far back and on the surface of the tongue as the tongue is extended out as far as possible. Next, the tongue scraper is pulled, gently, forward towards the tip of the tongue. The tongue scraper is then rinsed the procedure is repeated as needed, usually about 5-7 times.

Conclusion:

As such, the general hygiene of the mouth extends from just a toothbrush, floss, and mouthwash. Daily practices are held in place to not only maintain the health of the oral cavity, but the health of the entire body, as each body part is connected and impacted by one another.

In continuing with the “Circle of Health,” our next topic will discuss the promotion and maintenance of the other sense structures: the eyes, ears, and nose.