The four classical oral practices

Ashtanga Hridayam, Sutrasthana 2 documents four distinct oral hygiene practices in sequence. Each addresses a different aspect of oral health and has a different therapeutic rationale. They are prescribed as a sequence — each prepares for the next.

First

Danta Dhavana — tooth cleaning

Cleaning the teeth with a medicinal twig (Danta Kashtha). Classical texts specify the twig from Karanja (Pongamia pinnata), Neem (Azadirachta indica), Khadira (Acacia catechu), Vata (Ficus benghalensis), or Arka (Calotropis procera). Ashtanga Hridayam specifies the twig should be fresh (not dried), the thickness of the little finger, and approximately twelve finger-widths in length. The tip is chewed to expose the fibres — the frayed end functions as both brush and medicinal delivery. The bitter and astringent compounds from these specific species are documented as Krimighna (antimicrobial), Dashana Balya (tooth-strengthening), and reducing Kapha accumulation in the mouth.

Second

Jihva Nirlekhana — tongue scraping

Scraping the tongue with a metallic tongue scraper (Jihva Lekhana) to remove Jihva Lepa — the coating on the tongue that represents accumulated Ama and overnight Kapha deposits. Classical texts document tongue scrapers of gold, silver, or copper depending on constitution; modern practice uses stainless steel or copper. The direction is always from back to front — seven passes. Ashtanga Hridayam documents Jihva Nirlekhana as clearing Ama from the oral cavity before it is re-swallowed, improving taste perception (by removing the barrier over taste receptors), and stimulating the digestive reflex that prepares Jatharagni for the day.

Ashtanga Hridayam, Sutrasthana 2.3
"Jihva nirlekhana karayeth nityam — daily tongue scraping should be performed. It removes bad breath (Mukhashaucha), improves taste perception (Rasagrahana), and clears the accumulated deposits (Mala) from the channels of the tongue." The three documented benefits — breath quality, taste perception, and channel clearance — reflect the classical rationale that the tongue is both a diagnostic organ (tongue examination reveals Dosha state) and a pathway for Ama to re-enter the body if not cleared.
Third

Kavala — oil swishing

Taking approximately one tablespoon of warm sesame oil (or medicated oil for specific conditions — Dashana Sankha Churna in oil for dental conditions; Kshirivriksha Kashaya for gum conditions) and swishing it in the mouth for 2–3 minutes. Ashtanga Hridayam documents Kavala as building strength in the jaw and neck, preventing dental conditions, improving voice quality, and nourishing the oral mucosa through the absorbent tissue of the mouth.

Fourth

Gandusha — oil holding

Holding a full mouthful of warm sesame oil (the mouth should be completely full — unable to swish) for as long as possible — classically documented as 3–5 minutes or until the mouth fills with saliva and the oil becomes thin and white. Distinguished from Kavala by volume and intention: Kavala is movement for strength; Gandusha is holding for deep mucosal absorption and Kapha-drawing. Ashtanga Hridayam documents Gandusha specifically for dryness conditions — cracked lips, dry mouth, and Vata-type oral conditions.

Modern research context

Oil pulling (Kavala/Gandusha) has been the subject of modern research primarily investigating its effect on oral microbiome and gum health. Multiple randomised controlled trials (Journal of Ayurveda and Integrative Medicine; Indian Journal of Dental Research) have documented significant reduction in Streptococcus mutans counts and plaque scores comparable to chlorhexidine mouthwash — consistent with the classical Krimighna (antimicrobial) documentation. Coconut oil has been the most studied in modern research; sesame oil is the classical standard with documented antibacterial properties from sesamin, sesamolin, and sesamol compounds.

The tongue scraping practice has been documented in research primarily for its effect on oral volatile sulphur compounds (VSC) — the primary cause of bad breath. Daily tongue scraping reduces VSC significantly more than brushing alone, consistent with the classical documentation of Mukhashaucha (oral cleanliness) as a primary Jihva Nirlekhana benefit.

Constitutional variations
Ashtanga Hridayam documents the classical oil selection by constitution: Kapha constitution — sesame oil (heating, Kapha-reducing); Pitta constitution — coconut oil or Kshiravriksha Kashaya (cooling, Pitta-reducing); Vata constitution — warm sesame oil or Bala Taila (warming, Vata-nourishing). The single-oil-for-all approach in popular practice is a simplification of the classical individualised prescription.