Dantanadi (Dental Sinus) Causes, Pathogenesis, Symptoms, Treatment

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Dantanadi is a disease of the teeth / gums. It is explained in ‘dantamulagata rogas’ i.e. diseases of the gums or alveolar processes. This disease is characterized by the formation of sinuses at the root / gums of the teeth.
Danta = teeth, Nadi = sinus, passage
Read – Sensitive Teeth – Causes, Symptoms, Ayurvedic Treatment

Table of Contents

Types

Vataja nadi – caused by predominant vitiation of vata
Pittaja nadi – caused by predominant vitiation of pitta
Kaphaja nadi – caused by predominant vitiation of kapha
Sannipataja nadi – caused by simultaneous vitiation of all three doshas (vata, pitta and kapha)
Shalyajanya nadi – caused by foreign object

Modern correlation

The sinuses of the gums are formed as a complication of pyorrhea alveolaris. When pyorrhea alveolaris is not treated properly or incompletely treated the pus reaches the roots of the teeth and form sinuses. The gums in this disease become swollen and edematous especially at the margins. This results in pockets of pus which extend along the roots of the teeth eventually leading to the formation of sinuses.
In Ayurveda this condition has been classified into 5 types as mentioned above depending upon the predominant dosha causing the sinus or a foreign object involved. The symptoms of the sinus too will be in accordance to the predominant dosha involved or due to the impact of the foreign object over the gums.
Nadi / sinus is a subject of surgery. This condition has been separately explained in shalya tantra i.e. surgery. These sinuses can occur anywhere. The same sinus when occurs in the teeth is called as danta nadi – sinus of the teeth.
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Treatment

a. Samanya Chikitsa – General line of treatment of danta nadi
Danta Nadi are treated on the lines of nadi-vrana chikitsa i.e. treatment of sinus-ulcers as explained in surgical texts.

b. Vishishta Chikitsa – Specific line of treatment of danta nadi

Danta Uddarana / Total Extraction of the tooth with sinus – The tooth in which the nadi – sinus has been formed should be extracted. Before extracting the affected tooth the gums on all sides of the tooth shall be excised. The sinus will be removed along with the tooth without any remnants. The pus which had been accumulated in the tooth too will be eventually drained. This will subsequently cause healing of the wound around the afflicted tooth.
Read – Danta Veshta – Causes, Symptoms, Treatment, Modern Correlation

Dahana – Agnikarma / Cauterization of the afflicted part – In spite of the extraction of the tooth if the disease doesn’t get cured, the afflicted region shall be subjected to cauterization using alkali or fire.

Reason for extraction of tooth with sinus – If the tooth with sinus is not properly extracted or if the sinus is not dealt properly healing doesn’t take place completely. The sinus which has been left out would make its path deep inwards into the jaw and would undoubtedly destroy the jaw bone. Therefore the tooth with sinus should be completely extracted by its root, without any part of the tooth remaining. If the sinus has reached till the bone and has destroyed the bone of the jaw, the pieces of the destroyed jaw bone shall be removed and the lesions cleansed.

Master Sushruta has clearly denied and contraindicated extraction of tooth with sinus from the upper jaw. Thus, if sinus is formed in any tooth of the upper row of teeth it should not be extracted totally. This also means to tell that the above explained measures are only for extracting the ‘tooth with sinus’ from the lower row of teeth.
He tells that the teeth of the upper jaw are located deep inside their bone (socket of the jaw bone) i.e. they are deeply rooted and their relationship with their gums will be of a stable nature i.e. they are not easily separable. The gums of the upper row (jaw) hold their teeth firmly.
If we try to forcibly extract the ‘tooth having sinus’ from the upper jaw it would lead to severe bleeding and consequentially cause many complications related to blood loss. The complications of such procedure are loss of vision in one eye or facial paralysis. Even if the tooth having sinus located in the upper jaw / row of teeth is loose and shaking it shall not be extracted. In cases of dantanadi the tooth extraction should be done only when the afflicted tooth is in lower row of teeth.
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Dhavana – mouth wash / rinsing – After the extraction of the tooth the decoction prepared with the below mentioned herbs shall be given for washing the mouth. It can be used for rinsing or for gargle. The ingredients of the decoction are –
Jatyadi Kashayam
Jati – leaves of jasmine plant
Madana – leaves of Randia dumetorum
Swadu Kantaka – Tribulus terrestris
Khadira – bark of Acacia catechu

Shodhana – wound cleansing – To cleanse the wounds around the sinus the oil prepared with the decoction of the below mentioned ingredients shall be used –
Jatyadi Taila
Jati Patra – leaves of jasmine plant
Madana – Randia dumetorum
Katuki – Picrorhiza kurroa
Svadu kantaka – Tribulus terrestris
Yashtyahva – Glycyrrhiza glabra
Lodhra – Symplocos racemosa
Manjishta – Rubia cordifolia
Khadira – Acacia catechu