INTERNATIONAL AYURVEDIC MEDICAL JOURNAL Review Article ISSN: 2320 5091 Impact Factor: 4.018 PRIMARY TOOTH ERUPTION - AN AYURVEDIC OVERVIEW S. Asha Research Officer (Ay), Dr. A. Lakshmipathi Research Centre for Ayurveda, Chennai, Tamil Nadu, India Email: [email protected] ABSTRACT Teething is the process by which an infant's first teeth, the deciduous teeth sequentially appear by emerging through the gums, typically arriving in pairs1. It is an important landmark in assessing the growth and development of a child. Though there have been many references regarding dental care and dental disorders in Ayurveda, paediatric dentistry is an area which is poorly dealt with. Kashyapasamhitha, the authentic Ayurvedic classical book in paediatrics incorporates a sepa- rate chapter – Danthajanmikam adhyayam which deals with primary tooth eruption and its various aspects like types of tooth eruption, factors influencing tooth eruption, variations and disorders of eruption, period of tooth eruption and its ef- fects etc. Vagbhata has dealt mainly the complications arising during dentition and how to mitigate them safely and effec- tively. An attempt has been made to combine various references about primary tooth eruption from classical Ayurvedic text books and to re-interpret them in the light of modern scientific studies and knowledge. Keywords: Ayurveda,Paediatric,Dantajanma, tooth eruption, Danta INTRODUCTION Ayurveda has included dentistry in Salakya tantra, one incisors, two lateral incisors, two canines and four mo- among the Ashtangas. Oral care has been given much lars (no premolars and third molars). importance in Ayurveda. Rules of brushing teeth (Dan- Pediatric dentistry in Ayurveda is an area which is least tadhavan), tongue scrapping (Jihwa nirlekhanam) and appraised. Teething is considered as an index of growth other oral cleansing measures are included in the daily and development of children. Time of eruption and regimen practices. Diseases of tooth and gums are ex- health of teeth indicates the level of maturity of asthid- plained with their pathology and clinical manifestations. hathu in children. Variations or disorders in these can be Treatment has been indicated specifically for each dis- a sign of any underlying pathology. Kashyapa Samhitha, ease. All classics of Ayurveda have accepted number of the authentic paediatric text in Ayurveda has given char- teeth along with their sockets as thirty-two. As per Ka- acteristics of ideal teeth and also has explained time and shyapa Samhita, the authentic Ayurvedic paediatric text- mode of eruption of ideal teeth in chapter Danthajanmi- book, out of these,eight erupt once (Sakrijjatha) and the kamadhyayam. Disorders of tooth eruption and un- rest erupt twice (dwija). The central incisors are called healthy characteristics of teeth are also narrated. These Rajadanta, lateral incisors as Bastadanta, canines are are on par with that of modern dentistry. Safe and effec- called as Damshtra and the rest which grow in original tive methods can be adopted from Ayurveda to relieve roots are called Hanavya2. In what so ever month teeth teething disorders and to speed up the teething process. erupt after birth, shedding occurs in the corresponding Ayurvedic medicines can be successfully applied in den- year of life. Primary dentition is comprised of 20 teeth, tistry as antiseptic, antioxidants, and analgesic. which exfoliates as the primary teeth erupt. For Primary dentition, in each arch of mouth, there are two central S. Asha: Primary Tooth Eruption - An Ayurvedic Overview Physiology of tooth formation and eruption: begin in the eighth month of life10. The dhathus which Danta is considered as the upadhatu of Asthi dhatu .It are involved in the eruption of teeth are Asthi and has predominance of Prithvi and vayumahabhuta3 and Majja11. The dhathus get localised in the root of gums contributes for the stoutness and rigidness of tooth. and along with doshas results in tooth eruption. The Caraka has included teeth among the body parts which Dhatubija or tooth buds consists of localised prolifera- grow after birth4. Classics have accepted number of teeth tion of cells in the dental lamina. These buds grows into along with their sockets as thirty two5,6,7.The Dasanas or mesenchyme and develops into primary teeth. As per Dantas are considered as Ruchakasthi, one among the various studies, on an average, the eruption of primary type of Asthi’s8. teeth begins at about the age of 8 months with the man- The teeth develop from ectoderm and mesoderm. The dibular central incisors, and ends at the age of about 30 development is in four continuous stages - initiation months with the maxillary second molars. Thus, in most stage, bud stage, cap stage, bell stage and then matura- children the total period of eruption of primary teeth ex- tion. In the initiation stage the dental lamina connects the tends for about 2 years. The eruption phase has been developing tooth bud to the epithelial layer of mouth. classified into the following stages: pre-eruptive; in- During the Bell stage, localized proliferation of cells in traosseous; mucosal penetration; pre-occlusal; and post- the dental laminae forms round or oval swellings, the occlusal. In the pre-eruptive stage, the tooth crown is tooth buds, which grow into the mesenchyme. In the cap formed and the position of the tooth within the jaw bone stage, the deep surface of each ectodermal tooth bud be- is relatively stable. In the intraosseous stage the root be- comes invaginated by mesenchyme called the dental pa- gins to form and the tooth starts by much slower move- pilla, which gives rise to the dentin and dental pulp. The ment, moving inside the jaw bone towards the oral cav- ectodermal, cap-shaped covering over the papilla is ity. The mucosal penetration stage occurs, in general, called an enamel organ as it produces the future enamel when half to three-fourths of the root of the erupting of the tooth. Hard tissues, including enamel and dentin, tooth has been formed. The pre-occlusal stage is rela- develop during the next stage of tooth development i.e. tively short, whereas the post-occlusal stage is much the crown, or maturation stage9. longer and it is characterized by much slower tooth Tooth eruption is described as the movement of a tooth, movement. Although the movement of teeth during primarily in the axial direction, from its site of develop- eruption primarily occurs in the axial direction, the teeth ment in the jaw bone to its functional position in the oral actually move in all the three planes of space12. cavity As per Ayurveda, ideally tooth eruption should Table 1: Primary tooth eruption and period of eruption13 Upper Erupts by Lower Erupts by Central incisor 8-12 months Central incisor 6-10 months Lateral incisor 9-13 months Lateral incisor 10-16 months Canine 16-22 months Canine 17-23 months First molar 13-19 months First molar 14-18 months Second molar 25-33 months Second molar 23-31 months Complications of early teeth eruption: 6th month- Teeth will be inverted, covered with plaques, As per Ayurveda, ideally tooth erupts by 8th month. discoloured and can be easily afflicted with dental caries. When eruption occurs prior to this, there can be various 7th month- Teeth will be having two pockets, split, bro- complications. ken, stripped, dry, irregular and protruberant14. 4th month- Teeth will be of less strength and can lead to These complications can be due to immaturity of early decay and various other diseases. dhathus involved in tooth formation and eruption. Stud- 5th month- Teeth will be shaky, increased sensitivity and ies have failed to point out any specific cause for prema- can lead to various other diseases. ture eruption of teeth. However few endocrine or genetic IAMJ: Volume 7, Issue 1, January - 2019 (www.iamj.in) Page 127 S. Asha: Primary Tooth Eruption - An Ayurvedic Overview factors may be involved in it as in congenital adrenal teeth are characteristics of good teeth. Ideal teeth should hyperplasia. be supported with gums which are even, red, compact, Factors influencing tooth eruption: unctuous and with big, compact, stable roots. Studies Physiological variation in the normal eruption of teeth is have shown that appearance of lips, appearance of dental a common finding, but in case of significant deviation, arches, shape of teeth, teeth colour and appearance of evaluation of health and development of child should be gums contribute to the aesthetics of teeth and surround- done. Kashyapa has mentioned few factors like Lingab- ing structures22. heda (Gender difference), Jaathivisesha (Racial differ- The following four major tissues make up a healthy ence), Mathapithroranukaranam (Genetic and hereditary tooth – enamel, dentin, cementum, and dental pulp. factors), swabhavam (Natural or other unknown causes), Enamel- It is the hardest and the most highly mineralised Swakarmavisesham (Nutrition of the child) etc which substance of human body. 96% of enamel comprises of normally influence primary tooth development and erup- mineral, with water and organic material composing the tion in children. rest. Its normal colour varies from light yellow to grey- Gender – As per Ayurvedic classics, appearance of teeth ish white. Dentin- It is the porous and yellow hued mate- in female babies are early and cause less trouble while in rial, which works as a protective layer and supports the males it takes much time and causes difficulties due to crown of tooth. Dentin is a mineralized connective tissue compactness of teeth and stable nature of gums15. Stud- with an organic matrix of collagenous proteins. Cemen- ies conducted on tooth eruption also prove this16. The tum- It is a specialised bone like substance wrapping the difference in eruption times between both genders on root of tooth. It is yellowish and softer than dentin and average is from 4 to 6 months, largest difference being enamel. Dental pulp – It is the central part of the tooth for permanent canines.