Introduction

Nature always stands as a golden mark to exemplify the outstanding phenomena of

symbiosis. Natural products from plant, animal and minerals have been the basis of
the treatment of human disease.

Today estimate that about 80 % of people in developing

countries still relays on traditional medicine based
largely on species of plants and animals for their
primary health care. Herbal medicines are currently in
demand and their popularity is increasing day by
day.About 500 plants with medicinal use are mentioned
in ancient literature and around 800 plants have been
used in indigenous systems of medicine. India is a vast
repository of medicinal plants that are used in traditional
medical treatments (Chopra et al., 1956). The various
indigenous systems such as Siddha, Ayurveda, Unani
and Allopathy use several plant species to treat different
ailments (Rabe and Staden, 1997). The use of herbal
medicine becoming popular due to toxicity and side
effects of allopathic medicines. This led to sudden
increase in the number of herbal drug manufactures (Agarwal, 2005).
Herbal medicines as the major remedy
in traditional system of medicine have been used in
medical practices since antiquity. The practices
continue today because of its biomedical benefits as
well as place in cultural beliefs in many parts of world and have made a great
contribution towards
maintaining human health (Sane, 2002).
In India around 20,000 medicinal plant species have been recorded recently but more
than 500 traditional communities use about 800 plant species for curing different
diseases (Kamboj, 2000). Currently 80% of the world population depends on plant-
derived medicine for the first line of primary health care for human alleviation
because it has no side effects. Plants are important sources of medicines and presently
about 25% of pharmaceutical prescriptions in the United States contain at least one
plant-derived ingredient. In the last century, roughly 121 pharmaceutical products
were formulated based on the traditional knowledge obtained from various sources.

Herbal medicines obtained from plants

India has one of the richest plants medical traditions in the world. There are estimated
to be around 25,000 effective plant-based formulations, used in folk medicine and
known to rural communities in India. There are over 1.5 million practitioners of
traditional medicinal system using medicinal plants in preventive, promotional and
curative applications. It is estimated that there are over 7800 medicinal drug-
manufacturing units in India, which consume about 2000 tonnes of herbs annually.
Market value of herbal medicines
The market for ayurvedic medicines is estimated
to be expanding at 20% annually. Sales of medicinal
plants have grown by nearly 25% in India in past ten
years (1987-96), the highest rate of growth in the world
(Masood, 1997 <http://www.ejbiotechnology.info/
content/vol7/issue3/full/5/index.html>). But the per capita expenditure in India on
medicines per annum is amongst the lowest in the world. In other developing
countries too, plants are the main source of medicine.
Two of the largest users of medicinal plants are China
and India. Traditional Chinese Medicine uses over 5000
plant species; India uses about 7000. According to
Export Import Bank, the international market for medicinal plant related trade having
a growth rate of 7% per annum. China’s share in world herbal market is US$ 6 billion
while India’s share is only US$1 billion.
The annual export of medicinal plants from India is
valued at Rs. 1200 million. All the major herbal-based
pharmaceutical companies are showing a constant
growth of about 15 per cent. Traditional medicine has
served as a source of alternative medicine, new
pharmaceuticals, and healthcare products. Medicinal
plants are important for pharmacological research and
drug development, not only when plant constituents
are used directly as therapeutic agents, but also as
starting materials for the synthesis of drugs or as
models for pharmacologically active compounds
(Mukherjee, 2003 <http://www.ejbiotechnology.info/
content/vol7/issue3/full/5/index.html>). A significant number of modern
pharmaceutical drugs are derived from medicinal plants. The derivatives of medicinal
plants are non-narcotic with little or no side effects.

Future prospects of herbal medicine market

It is estimated that nearly three fourths of the
herbal drugs used worldwide were discovered following
leads from local medicine. According to WHO about
25% of modern medicines are descended from plants
first used traditionally. Many others are synthetic
analogues built on prototype compounds isolated from
plants. Almost, 70% modern medicines in India are
derived from natural products.
The basic uses of plants in medicine will continue
in the future, as a source of therapeutic agents, and
as raw material base for the extraction of semi-synthetic
chemical compounds such as cosmetics, perfumes and
food industries. Popularity of healthcare plant-derived
products has been traced to their increasing
acceptance and use in the cosmetic industry as well
as to increasing public costs in the daily maintenance
of personal health and well being. In the dual role as a
source of healthcare and income, medicinal plants
make an important contribution to the larger development process. Though the
efficacy of herbal requires development of quality consciousness in respect of the
evaluation related evidences, supplying the demand for botanicals and herbals is a
booming business.
Recently even developed countries, are using
medicinal systems that involve the use of herbal drugs
and remedies. Undoubtedly the demand for plantderived
products has increased worldwide. The demand
is estimated to grow in the years to come fuelled by
the growth of sales of herbal supplements and
remedies. This means that scientists, doctors and pharmaceutical companies will be
looking at countries like China, India, etc. for their requirements, as they have the
most number of medicinal plant species and are the top exporters of medicinal plants.

Why herbal medicine?

Herbal medicines are being used by about 80% of the world
population primarily in the developing countries for primary
health care. They have stood the test of time for their safety,
efficacy, cultural acceptability and lesser side effects. The
chemical constituents present in them are a part of the
physiological functions of living flora and hence they are believed
to have better compatibility with the human body. Ancient
literature also mentions herbal medicines for age-related diseases
namely memory loss, osteoporosis, diabetic wounds, immune and
liver disorders, etc. for which no modern medicine or only palliative
therapy is available. These drugs are made from renewable
resources of raw materials by ecofriendly processes and will bring
economic prosperity to the masses growing these raw materials.
A clinical study on Krimidanta with reference to dental caries and its
management
Dental caries is progressive destruction of enamel, dentine and cementum, initiated by
microbial activity at the tooth surface. It is one of the major problems in dentistry. On
the basis of clinical features, it can be compared with Krimidanta which is one among
the eight diseases of tooth. In the management of Krimidanta, Krimighna, Vataghna
and Ushna Veerya dravyas are to be used which can relieve the toothache and
discoloration. In this study, the trial drugs used were Tablet of medicinefor
Pratisarana and Powder of medicine for oral administration. In this study, the patients
of Krimidanta (dental caries) were selected from OPD of Shalakya Department and
allotted randomly in different groups. In Group A, the patients were treated with
Tablet of medicinefor Pratisarana for 30 days. In Group B, the patients were treated
with Powder of medicine orally and Group C patients were treated with combined
therapy for 30 days. The clinical study has shown that combined therapy gives better
results than individual therapies.
Introduction

Teeth are very precious organs of the body, governing lot of functions like chewing,
speech control, giving shape to the mouth and the most important of all is to maintain
the beauty of the face; once they are destroyed, they cannot regrow. [1] Eight Danta
Rogas are described by Acharya Sushruta; of them, Krimidanta is the one which
gradually results in tooth loss, if not treated in time.

Krimidanta is characterized by black discoloration, cavity formation, swelling, pus

and blood oozing and severe pain. [2] It occurs due to vitiation of Vata followed by
Pitta and Kapha Dosha.

Dental caries often leads to fatal infection and may lead to death, if the patients do not
take proper treatment. [3] Oral infections in patients with rheumatic or congenital heart
diseases are particularly dangerous, as they can lead to the risk of infective
endocarditis. [4]

Knutson’s technique is widely recommended for topical application of sodium

fluoride to the teeth. The effectiveness of topical fluoride administration is
questioned. [5] An operative procedure such as filling and R.C.T. techniques have their
own limitations. As per the World Health Organization (WHO) technical report 1995,
19 billion individuals per year are affected by dental caries; thus, this disease poses a
challenge to the dentists. All these facts leave a scope to search a better remedy to the
problem.

In Ayurvedic texts, a good number of medicaments are explained for strengthening

the teeth and gums. These remedies are made from various plants and applied to the
gums and tooth in the form of powders, oils, etc. In addition to this, bloodletting is
also described in classics. In the management of Krimidanta, the drugs having
Krimighna (antimicrobial), Vranaghna and Ushna Veerya are to be used which can
relieve the toothache and Krimi. In the present study, the trial drugs used were Tablet
of medicinefor Pratisarana and Powder of medicine (Bhaishajya Ratnavali 61/99,
30/11) [6] for oral administration.
Aims and objectives

The present study was based on following aims and objectives.

1. To study the etiopathogenesis of Krimidanta (dental caries) from
Ayurvedic and modern points of view.
2. To evaluate the efficacy of Tablet of medicineand Powder of medicine in
signs and symptoms of Krimidanta (dental caries).

Materials and Methods

Source of data

In the clinical trial of Krimidanta (dental caries), the patients were selected from OPD
and IPD of Shalakya Tantra department, IPGT and RA hospital, Jamnagar and were
randomly assigned into three groups, viz., Groups A, B and C. A total of 40 patients
were registered and randomly distributed in three groups, comprising 14 patients each
in Groups A and C and 12 patients in Group B.

Inclusion criteria

The patients were diagnosed on the basis of the signs and symptoms of Krimidanta
(dental caries) and these patients were included in the clinical study.

Exclusion criteria

Patients with the following were excluded:

• age below 10 years and above 60 years,
• fractured tooth,
• patients with periodontal abscess and
• patients with other diseases of oral cavity.

Ethical clearance

The study was cleared by the ethical committee of the institute. Written consent was
taken from each patient willing to participate, before the start of the study. For those
patients who were unable to read or write, consent of their relatives was taken.
Patients were free to withdraw their names from the study at any time without giving
any reason.

Tablet of medicineand Powder of medicine preparation

”Jatipatradi Gutika” and “Powder of medicine” were prepared according to the
standard method of preparation of Gutika and Churna, respectively, in the pharmacy
of Gujarat Ayurved University. The Ingredients of Tablet of medicineare Jatipatra
(Jasminum grandiflorum), Ajamoda (Carum Roxburghianum), Shunthi (Zingiber
officinale), Punarnava (Boerhavia diffusa), Musta (Cyprus rotundas), Hareetaki
(Terminalia Chebula), Jhintipatra (Barleria prionitis), Vacha (Acorus calamus), and
Tila (Sesamum indicum). Powder of medicine consists of five drugs, viz., Yavani
(Trachispermum ammi), Hareetaki (T. Chebula), Hingu (Ferula Foetida), Saindhava
(sodii chloridum impura) and Sauvarchala (Unaqua sodium). [7],[8]

Assessment criteria

An assessment was made on the basis of change in clinical features before and after
treatment and scoring was given to each symptom with scores ranging from 0 to 3.