Primary Tooth Eruption - an Ayurvedic Overview

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

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

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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. This is attributed to early onset of filled with soft connective tissue. Dental pulp encloses maturation in females. blood vessels and nerves that enter the tooth from a hole Racial – Difference in time of tooth eruption exists at the apex of the root23. Ideal characteristics of these among different races (Jathi visesha). Teeth emerge con- tissues indicate the maturity and health of Asthi and siderably earlier in African and American-African chil- Majja dhathus. dren than in Asians and Caucasians 17. Symptoms associated with tooth eruption and their Genetic – Genetic factors are proved to have effect in management: Tooth eruption takes place during an 8- emergence of teeth by analysing the concordance rate day window that includes 4 days before tooth eruption, among monozygotic and dizygotic twins18. the day of eruption and the 3 subsequent days. Mostly, Natural causes-There can be some natural or unknown the primary teeth pierce the gums without causing any factors which determines the time of teeth eruption in symptoms. Systemic and local signs and symptoms as- children. cribed to primary tooth eruption include general irritabil- Nutritional factor- There is evidence that chronic malnu- ity, sleep disturbances, crying, fussiness, rhinorrhea, fa- trition extending beyond the early childhood is associ- cial flushing, fever, diarrhoea, loss of appetite, drooling, ated with delayed teeth eruption19. It has been found that ear rubbing on the side of the erupting tooth, inflamma- children from higher socioeconomic backgrounds have tion of the gums overlying the tooth, gum irritation, and earlier tooth emergence than children from lower socio- increased biting. Though there has been some associa- economic classes as children from higher socioeconomic tion between tooth eruption and these symptoms, studies class get better health care, nutrition and these factors have failed to trace out any causal relationship24. During influence earlier development of dentition. teething, Asthi and Majja dhathus located in the both Others- Other factors like craniofacial morphology, jaws gets mature and undergoes ripening. This leads to hormonal factors and various systemic and genetic fac- slight swelling in the gums. Rubbing between both gums tors influence the time and mode of teeth eruption. results in horripilations to the child. Presence of Kapha Ideal teeth characteristics causes itching and the child gets tendency to take every According to Ayurveda, teeth which erupt in eighth object to mouth for relief. Also there will be changes in month possess ideal qualities20 and are an indication of feeding habits and digestive disturbances. Child bites longevity21. Completeness, evenness, compactness, niiples of mother while feeding and when it gets devoid whiteness, unctuousness, smoothness, cleanliness, dis- of food, child yawns. This may lead to vitiation of vata. ease-free state and slight protuberance of upper row of Vata along with kapha gets localised in dantasayas and IAMJ: Volume 7, Issue 1, January - 2019 (www.iamj.in) Page 128

S. Asha: Primary Tooth Eruption - An Ayurvedic Overview then moves all over body along with pitha. This results In diarrhoea associated with ama and diarrhoea with in various secondary diseases to the child by vitiating blood, powder of gajapippali(piper chaba)or devadaru other dhatus and malas25. Vagbhata has mentioned teeth (Cedrus deodara can be given with sugar. eruption as the cause for systemic and local diseases like Treatment of headache- Paste prepared with leaves of fever (jwara), diarrhoea (vitbheda), cough Kapittha (Feronia limonia), Changer (Oxalis cornicu- (kasa),vomiting (chhardi), headache(siroruja), various lata), Badari (Prunus domestica) and Kakamachi (So- ocular (Abhishyanda and pothaki) and skin manifesta- lanum nigrum) mixed with ghee should be applied cold tions (visarpa). Vagbhata has explained Kukunaka, an on head. This will relieve headache, vomiting and diar- inflammatory disease of eye to be the secondary compli- rhoea. cation of dantotpathi26. He has stated that the diseases Treatment of eye diseases- For ocular manifestations are self limiting and subsides when the eruption is com- like kukunaka and pothaki, specific treatment should be pleted27, but mild measures can be opted to ease out the adopted. However, vagbhata has indicated to use pills situation. Gums can be rubbed with powdered drugs like made of manassila (Realger), Sankhanabhi (conch), pip- Pippali, flower of Dhataki and Dhathri by mixing with pali (piper longum),, madhuyashi (Glycerrhiza glabra) honey. Powder of dried meat of certain birds like lava, mixed with honey generally in eye diseases of children. tittiri mixed with honey can also be used for this pur- Treatment of excessive thirst, diarrhoea, vomiting – pose. Studies have proved that light massage or rubbing powder of priyangu (Callicarpa macrophylla), anjana over gums with clean fingers or very soft finger (extract of Berberis aristata) and mustha (Cyperus ro- toothbrush for 1-2 minutes are good teething remedies as tundus) should be consumed along with rice washed wa- it reduces the swelling and thickness of gums28. Ghee ter. formulations like Vachadi and Samangadi Ghritha can Treatment of fever of kapha origin- Medicated ghee be used in general to lessen difficulties arising during should be prepared with Madhuka (Madhuka longifolia), teething29For managing the secondary manifestations vacha (Acorus calamus),vyosha (Piper longum, Zingiber associated with teething, symptomatic treatment should officianalis and Piper nigrum) etc, consumed with honey be adopted considering the vitiated dosha, origin and cures fever of kapha origin and acts as a best carmina- stage of disease, time, place etc. Only Ashtanga Sam- tive.30 graha has mentioned specific treatment for each compli- Disorders and variations of tooth eruption: cation arising during teething. Apart from ideal teething, Kashyapa has mentioned Treatment of fever of vata origin- Child should be various disorders of eruption like: made to drink syrup prepared from bhadradaru (Cedrus Samudga- decrease in number of teeth due to continuous deodara), Ghana (Cyperus rotundus), yashti (Glycer- falling. rhiza glabra) and samanga (Rubia cordifolia) with sugar Samvrta- inauspicious and dirty candy. Vivrta – worn-out, with excessive salivation, gets easily Decoction or ghee prepared with drugs like Surahwa discoloured due to being uncovered and easily afflicted (Cedrus deodara), Ghana (Cyperus rotundus), yashti with diseases. (Glycerrhiza glabra) etc can be used for oral intake or Kashyapa opines that birth with teeth or Natal teeth (Sa- for anointing. dantajanma), eruption of upper teeth first (Poorvamutta- Oil prepared with Haridra(Curcuma longa), ku- radantajanma), scattered teeth (Viraladanta), less teeth shta(Saussurea lappa), vacha(Acorus calamus) etc can (Heenadanta), more number of teeth (Adhikadanta), ter- be used for massaging. rible looking teeth (Karaladanta), discoloured teeth Treatment of fever, diarrhoea, vomiting and thirst- (Vivarnadanta) and cracked teeth (Sphutithadanta) are powder of parched paddy, neelotpala (Nymphaea stel- considered as variations from normal teething and are lata), kana (Piper chaba), madhuka (Glycerrhiza inauspicious31. These can be considered as signs of un- glabra), anjana (extract of Berberis aristata) with sugar healthy maturation of body tissues and early indicators and honey can be given fever of pitta origin and diar- of developmental disorders in children. rhoea. Natal /neonatal teeth: Decoction of parched paddy, pippali (piper longum), Children with high birth weight have been reported to gajapippali (piper chaba) with sugar and honey cures have earlier eruption of their primary teeth than children fever, diarrhoea, thirst and vomiting. with normal or low birth weights. Teeth present at birth IAMJ: Volume 7, Issue 1, January - 2019 (www.iamj.in) Page 129

S. Asha: Primary Tooth Eruption - An Ayurvedic Overview are known as natal teeth and those that erupt within the Variations in tooth morphology: first month of life is known as neonatal teeth. Approxi- Kashyapa has described unideal morphological charac- mately one in 2000-3000 live births is so affected. The ters of teeth like terrible looking teeth (Karaladanta), mandibular central incisor is the most common natal or discoloured teeth(Vivarnadanta) and cracked neonatal tooth32. Vagbhata also suggests that birth with teeth(Sphutithadanta). Generally men have larger teeth teeth and eruption of upper teeth first are not ideal and than women. Racial differences have also been seen in has suggested doing specific pacifications33. Child born size of tooth. Tooth size is defined as abnormal when with teeth is considered to be due to excessive sleshmala dimensions have two standard deviations from average37. diet by pregnant woman34. Natal teeth or neonatal teeth Crown size: Teeth which are obviously larger than nor- tend to have abnormal roots. If the teeth are mobile there mal are referred to as megadont or macrodont and teeth is probability of aspiration and should be extracted. which are smaller than normal are termed microdont. Breastfeeding can be painful in natal or neonatal teeth35. Generalized megadontia has been reported in connection The mobility of the tooth frequently causes inflammation with conditions like pituitary gigantism, unilateral facial of the surrounding gingivae. Trauma to the ventral sur- hyperplasia and hereditary gingival fibromatosis. Micro- face of the tongue may cause ulceration. Natal or neona- dontia can occur in association with hypodontia as in the tal teeth may be seen in association with syndromes like example of X-linked hypohidrotic ectodermal dysplasia, Pachyonychia congenita, Ellis-van Creveld syndrome, where a heterozygous female might have one missing Hallermann-Streiff syndrome etc. lateral incisor and a peg-shaped crown of the contralat- Delayed eruption eral maxillary lateral Incisor. Delayed eruption of primary teeth may arise from either Root size: Larger than normal roots are most often seen systemic or local factors. It may also be associated with affecting the maxillary central incisors. Short roots may prematurity or low birth weight. Delayed eruption of also be seen in a number of conditions affecting the den- teeth is seen in association with Down syndrome and tine and/or pulp and may be seen affecting the maxillary Turner's syndrome. Delayed eruption is seen in nutri- central incisors. tional abnormalities and in endocrine disorders such as Invaginated teeth: hypothyroidism or hypopituitarism Des invaginus or invaginated teeth is a malformation of Variations in number of teeth: teeth most likely resulting from an infolding of the den- Hypodontia is the term most often applied to a situation tal papilla during tooth development or invagination of where a patient has missing teeth as a result of their fail- all layers of the enamel organ in dental papillae. ure of development or other systemic illness. Anodontia Evaginated teeth: describes the total lack of teeth of one or both dentitions. It is the abnormal evagination of the internal enamel epi- Oligodontia is a term used to describe a situation where thelium and dental papilla into the stellate reticulum. more than six teeth are missing. This may be Supernu- Evaginated teeth, or dens evaginatus, most commonly merary teeth or excess numbers of teeth are most often affect the premolar teeth.38 located in the anterior maxilla in the midline, or immedi- Taurodontism: ately adjacent to the midline, and they are then referred It is a condition found in the molar teeth of humans to as a mesiodens. Supernumerary teeth in the molar re- whereby the body of the tooth and pulp chamber is gions adjacent or distal to the normal sequence of teeth enlarged vertically at the expense of the roots. As a re- are referred to as paramolars or distomolars respectively. sult, the floor of the pulp and the furcation of the tooth is Supernumerary teeth have significant association with moved apically down the root.39 invaginated teeth and cleft palate. Multiple supernumerary teeth are seen in cleidocranial dysplasia and in syn- Conclusion dromes such as oral-facial-digital syndrome type 1, Primary tooth eruption and various aspects associated 36 Gardner syndrome etc . These variations correlate with with it are explained in Ayurveda. Disorders of tooth Kashyapa’s concept of less number of teeth eruption and variations in primary tooth number and (Heenadanta), scattered teeth (Viraladanta) and more morphology explained in Ayurveda can be correlated number of teeth (Adhikadanta) which are considered as with that explained in modern dentistry. Factors which signs of unhealthy dentition. influence tooth eruption as explained by Kashyapa are

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S. Asha: Primary Tooth Eruption - An Ayurvedic Overview relevant in present era also and have been proved by sci- 17. Ruta Almonaitiene, Irena Balciuniene, Janina Tutkuvi- entific studies. Symptoms associated with teething can ene,Stomatologija, Factors influencing permanent teeth be managed well with Ayurvedic measures and also eruption,Part one – general factors , Baltic Dental and helps in speeding up the teething process. Scientific Maxillofacial Journal, 12: 67-72, 2010. 18. Ruta Almonaitiene, Irena Balciuniene, Janina Tutkuvi- validation of Ayurvedic dentistry is essential for its rec- ene,Stomatologija, Factors influencing permanent teeth ognition in modern era. eruption,Part one – general factors , Baltic Dental and Maxillofacial Journal, 12: 67-72, 2010. References 19. Ruta Almonaitiene, Irena Balciuniene, Janina Tutkuvi- 1. https://en.wikipedia.org/wiki/Teething. ene,Stomatologija, Factors influencing permanent teeth 2. Vriddha jeevaka, Kashyapa Samhitha, Chakhambha vis- eruption,Part one – general factors , Baltic Dental and vabharati, Varanasi, Reprint 2002, suthra sthana, Chapter Maxillofacial Journal, 12: 67-72, 2010. 20, Verse 4. 20. Vriddha jeevaka, Kashyapa Samhitha, Chakhambha vis- 3. Vagbhata, AstangaSamgraha ,Chaukhambha Sanskrit vabharati, Varanasi, Reprint 2002, suthra sthana, chapter series, Varanasi, ShariraSthana, Chapter 5,Verse 65. 20, verse 8. 4. Agnivesa, Charaka Samhita,edited and translated by Prof. 21. Vagbhata, AstangaSamgraha ,Chaukhambha Sanskrit P.V Sharma, Chaukambha publications, Sarira Sthana, series, Varanasi, Uthara Sthana , chapter 2,verse 20. Chapter 4,Verse14. 22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506250/ 5. Agnivesa, Charaka Samhita ,edited & translated by Prof. Assessment of esthetic characteristics of the teeth and sur- P.V Sharma, Chaukambha publications, Sarira rounding anatomical structures/ NatalijaPricaOreški, Asja Sthana,Chapter 7,Verse 6. Čelebić, and Nikola Petričević , Acta Stomatol Croat, 6. Susruta, Susruta Samhita with commentaries Niband- 2017 March; 51(1), 22–32. hasamgraha by Dalhana and Nyayacandrika by Gayadasa, 23. https://en.wikipedia.org/wiki/Human_tooth. Chaukambha Orientalia, Varanasi , 5th Edition, reprint 24. Signs and symptoms associated with primary tooth erup- 1992 , Sarira Sthana, chapter 5, verse19. tion: a clinical trial of nonpharmacological remedies, 7. Vagbhata, AstangaSamgraha ,Chaukambha Sanskrit se- Mahtab Memarpour, ElhamSoltanimehr, and Taher- ries, Varanasi, SariraSthana,Chapter5,verse 71. hEskandarian, BMC Oral Health-2015; 15:88 8. Susruta, Susruta Samhita with commentaries Niband- 25. Vagbhata, AstangaSamgraha ,Chaukhambha Sanskrit hasamgraha by Dalhana and Nyayacandrika by Gayadasa series, Varanasi, Uthara Sthana, chapter 2,verse 23. , Chaukambha Orientalia, Varanasi , 5th Edition, reprint 26. Vagbhata, Ashtanga Hridaya, Kaviraja Atridev 1992, Sarira Sthana, chapter 5,verse 20. Gupta(Commentator), Vaidya Yadunandan 9. https://discovery.lifemapsc.com/library/review-of- Upadhyaya(Ed.), Chaukhambha Sanskrit Sansthan, Vara- medical-embryology/chapter-77-development-of-the-teeth nasi,Fourteenth Edition, 2003, Uttara Sthana chapter 10. Vriddha jeevaka, Kashyapa Samhitha, Chakambha vis- 8,verse 19. vabharati, Varanasi, Reprint 2002, suthra sthana, chapter 27. Vagbhata, Ashtanga Hridaya, Kaviraja Atridev 20,verse 8. Gupta(Commentator), Vaidya Yadunandan 11. Vagbhata, Astanga Samgraha ,Chaukhambha Sanskrit Upadhyaya(Ed.); Chaukhambha Sanskrit Sansthan, Vara- series, Varanasi,Uttara Sthana,chapter 2,verse15. nasi,Fourteenth Edition, 2003, Uttara Sthana chapter 12. Goran Koch and Sven Poulsen,Paediatric dentistry- A 2,verse 43. clinical approach,A John Wiley and Sons Ltd, Publica- 28. Mahtab Memarpour, ElhamSoltanimehr, and Taherh tions , 2nd Edition,2009, Chapter15, Page No 197. Eskandarian, Signs and symptoms associated with pri- 13. https://www.ida.org.in/Public/Details/Teeth. mary tooth eruption- a clinical trial of non pharmacologi- 14. Vriddha jeevaka, Kashyapa Samhitha, Chakhambha vis- cal remedies, BMC Oral Health, 2015, 15:88. vabharati, Varanasi, Reprint 2002, suthra sthana, chapter 29. Vagbhata, Ashtanga Hridaya, Kaviraja Atridev 20, verse 8. Gupta(Commentator),Vaidya Yadunandan 15. Vriddha jeevaka, Kashyapa Samhitha, Chakhambha vis- Upadhyaya(Ed.), Chaukhambha Sanskrit Sansthan, Vara- vabharati, Varanasi, Reprint 2002, suthra sthana, chapter nasi,Fourteenth Edition, 2003, Uttara Sthana, chapter 20, verse 5. 2,verse 35-42. 16. Ruta Almonaitiene, Irena Balciuniene, Janina Tutkuvi- 30. Vagbhata, AstangaSamgraha ,Chaukhambha Sanskrit ene,Stomatologija, Factors influencing permanent teeth series, Varanasi, Uthara Sthana, chapter 2,verse 36-55. eruption,Part one – general factors , Baltic Dental and 31. Vriddha jeevaka, Kashyapa Samhitha, Chakhambha vis- Maxillofacial Journal, 12: 67-72, 2010. vabharati, Varanasi, Reprint 2002, suthra sthana, chapter 20,verse 6,7.

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S. Asha: Primary Tooth Eruption - An Ayurvedic Overview 32. Richard Welbury and Monty Duggal, Pediatric dentistry, 3rd edition,2005, United States by Oxford University Press Inc., New York, Chapter13,Page No 313. 33. Vagbhata, Ashtanga Hridaya, Kaviraja Atridev Gupta(Commentator), Vaidya Yadunandan Upadhyaya(Ed.), Chaukhambha Sanskrit Sansthan, Vara- nasi;Fourteenth Edition, 2003. Uttara Sthana, chapter 2,verse 62. 34. Vagbhata, AstangaSamgraha ,Chaukhambha Sanskrit series, Varanasi, Uthara Sthana, chapter 2,verse 56. 35. https://www.dentalcare.com/en-us/professional- education/ce-courses/ce352/eruption-problems. 36. Goran Koch and Sven Poulsen, Pediatric dentistry- A clinical approach, 2 nd Edition, 2009, Blackwell publish- ing Ltd., Chapter 14, Page No189. 37. Goran Koch and Sven Poulsen, Pediatric dentistry- A clinical approach, 2 nd Edition, 2009, Blackwell publish- ing Ltd., Chapter 14, Page No191. 38. Goran Koch and Sven Poulsen, Pediatric dentistry- A clinical approach, 2 nd Edition, 2009, Blackwell publish- ing Ltd., Chapter 14, Page No195. 39. https://en.wikipedia.org/wiki/Taurodontism.

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