Whatever fell beyond this boundary was probably not considered Ayurveda. In recent years, with newfound pride in its legacy, Ayurveda has regained its vitality to reclaim its rightful place.

In recent times, people seem to have regained interest in discovering different ways to stay  healthy for a long time into their old age. In sickness too, people often face a dilemma of choosing treatment from two available systems: modern or alternative. The former has built  its foundation on biomedical experiments and the latter has evolved from a lived human  experience of centuries. Alternative, which is also known as complementary medicine,  includes an array of systems ranging from scientific to folklore. It includes Yoga, acupuncture,  traditional Chinese medicine, and AYUSH. The AYUSH systems, which stands for Ayurveda,  Unani, Siddha, and Homeopathy, have an established conceptual framework – proven and  unproven – about the working of the normal human body, etiology of diseases and their therapy.  

Ayurveda, a tradition of India for over 5000 years, reached its zenith around 100 BC by which its earliest stalwarts had created a cogent system, which had a logical strong foundation, a  well-constructed edifice, and a demarcated boundary. Whatever fell beyond this boundary  was probably not considered Ayurveda. The authors, Charka, Susruta, Vagabhat and others compiled experience, gained over previous centuries, in well-defined texts like Charka  Samhita, Susruta Samhita, Ashtang Hridaya and others. Their intuition, observations, logic, and ethics set high standards for the pursuit of knowledge, which guided this tradition for a  long time. 

The treatises of Susruta and Charaka were translated into Chinese language in the 5th century  and into Arabic and Persian languages in the 8th century. The Arabic translation reached Europe  by the 12th century. The British showed some interest in Ayurvedic systems but after 1835, with  the passage of the English Education Act, they discouraged Ayurvedic and other native  systems and gave preference to practice of western medicine. For the past many centuries, the  system was not able to maintain original vigor and the knowledge withered or remained static.  

In recent years, with newfound pride in its legacy, Ayurveda has regained its vitality to  reclaim its rightful place. Many institutions have been working on different paths to reach a  common goal: seek the truth in ancient knowledge, preserve what is known and unravel the  unknown. After centuries of dormancy, multiple paths are reasserting the relevance of  Ayurveda. 

The path of the purists and preservationists:

The purists believe in the divine wisdom of  Ayurveda, which originated from Brahma who passed it to Prajapati who in turn handed it to  Atreya and so on. Among the Vedas, it is Atharva Veda, which describes diseases and therapy in a systemic manner, though there are references to diseases in the earlier Rig Veda. The purists follow the Ashtang (eight-fold) system of Vagabhat, which includes Kaya Chikitsa  (Internal medicine), Shalakya Tantra (Head, Eye and ENT), Shalya Tantra (Surgery), Agada  Tantra (Toxicology), Bhuta Vidya (Psychiatry), Kaumara Bhritya (Pediatrics), Rasayana  (Antiageing therapeutics) and Vajikarna (Fertility, aphrodisiacs). The classic practitioners  follow the ancient practices in letter and spirit, which they consider perfect and need no  modification.

Traditional practice:

The followers of this path are Ayurvedic doctors who get training from  government accredited Ayurvedic medical colleges. Their training includes curriculum like 

1. anatomy, physiology, and microbiology, which later culminates in learning Ayurvedic texts  from ancient masters like Vagabhat. They use traditional Ayurvedic methods and biochemical  tests and radiology to arrive at a diagnosis. Many traditional practitioners have no  compunction in using western medicines to treat their patients even if they are forbidden. 

Commercial:

In recent times people from all societies seem to have rediscovered the benefits  of plants and herbs in health and disease. Two reliable market reports estimate that the herbal  market size of the world could reach between 168 billion USD and 428 billion USD by 2026.  WHO estimates that approximately 3.5 billion people in developing countries use plant-based medicines. At present, half the medicines in the market have natural origin. 

Profit drives the followers of this path. The marketing campaigns make generous use of well meaning words like organic, natural, herbal, antioxidant, detox. Market compulsions lead to  claims that these products promote health, wellness, strength, cure diseases and are harmless  without side effects. Such claims may not be Illegal but are often unsubstantiated.  

Currently, India has a small share of the world market, partly because of poor R&D and  quality standards. For international acceptance, recourse to clever marketing is essential but  not sufficient. Integration with international markets would be possible if Ayurveda pursues  intellectually honest research through established scientific methods to establish its veracity. The seekers of truth in ancient times used analytic methods available then and in modern  times we should not be reluctant to use the tools of science available now. The integrated  R&D could extend to manufacturing to match international quality. This could yield  enormous economic benefits.

Public health:

Ayurveda has inherent strength in its philosophy to contribute vastly to public  health. Unfortunately, this strength remains underutilized. An Ayurvedic public health  system, with its holistic approach, could lead common folks to a healthier lifestyle. With its  development and investment, an effective Ayurvedic health system could lead many public  health functions: prevention of the preventable diseases, improving nutrition, promotion of  physical activity, Yoga, mental health, and rehabilitation of the disabled. A dedicated public  health system based on Ayurvedic principles will go a long way to reduce disease burden.

Advocacy:

Activists and believers have pursued this path to persuade the government to  become enablers of an AYUSH eco-system. Their efforts have succeeded in opening new  organizational structures, institutions, and funding for various avenues of growth. More needs  to be done in basic research, standardization of therapy, patent laws, consumer protection and  integrated education.

Integrative medicine:

Healthcare will flourish when we harmonize the biomedical system  with Ayurveda; for too long these two have been running on parallel and often antagonistic  tracks. It helps vested interests to keep the two systems in conflict; it is time to find synergies  between them. The results of such merger should be quantifiable, replicable, and verifiable.  Making the impact quantifiable avoids inscrutable jargon which is a part of intuitive claims. Two myths prevail about Ayurveda. One held by biomedical doctors, who decry Ayurveda as  quackery and the second perpetuated by Ayurvedic practitioners that their treatment has no  bad side effects. Both are wrong. Here are two true stories from real life to counter both myths. 

A close friend had severe vertigo; his head would swirl unless he lied down immobile. These  episodes affected his personal and professional life. He spent a few years in treatment from  many modern medicine doctors including one at a reputed academic center but got no relief.  Out of desperation, he went to a prominent Ayurvedic clinic and under their therapy he got  considerable relief.  

In contrast, another friend was treated by an Ayurvedic doctor for abdominal pain, which  worsened despite the caring diligence of the doctor. After many months, when she switched to  a modern medicine doctor, it was too late. She succumbed to her disease and died soon after,  partly due to her disease and partly due to toxicity of the herbal drugs. The implication of these stories is that modern medicine should discard its smug superiority  and Ayurveda should shed off its halo of holiness. None of them can claim to be a panacea.  

Doctors already in practice could be offered courses both in Ayurveda and modern medicine to enhance their skills.

Integration of the two systems could happen in the medical college or later at practitioner  level. Students enrolled in modern medical colleges could take a course in Ayurveda; those  who want to specialize could be offered advanced courses following MBBS. Doctors already in  practice could be offered courses both in Ayurveda and modern medicine to enhance their  skills. Over the long run, the two-track medical education of Ayurveda and modern  biomedical medicine could be integrated into a single track; synthesis of the two systems  could evolve into a modern Indian system for healthcare delivery. The consumer would  benefit if she were not faced with the dilemma of choice.

Biomedical model:

Last two centuries have seen marked advances in understanding health  and disease by studying the human body as a biological machine. Investigators of the biomedical  model have developed a molecular basis of understanding the normal and abnormal  functions of the human body in health and disease. New diagnostic technology has evolved in  tandem to understand what was mysterious before. Therapeutic knowledge has exploded in  this field of biomedical models so that humans now live longer and healthier than even before  in history.  

There are groups of investigators, who are diligently using modern tools to unravel the  ancient knowledge. Some excellent work has been published in scientific journals and can be  searched in medical knowledge data banks like PubMed and others. To globalize the  knowledge and products of Ayurveda, we should meet international standards of research and product approval. The current gold standard is publication is a high impact peer reviewed  journal and approval from the FDA, USA. A serious inquiry into the ancient may reveal  kernels of truth and some fallacies. We should be bold to discard the fallacies and welcome  the truth. 

Like many others in this field, our group, Atrimed (Named after sage Atreya, teacher of  Charaka and Susruta) has also been working on an integrated Ayurvedic-biomedical model. Since 2003 we have been investigating the molecular basis of ancient therapeutics. We  believe that plants, which have evolved for over 2 billion years, can inspire new drug discovery. Plants are factories of nature. Phytochemicals and secondary metabolites can lead to new  bioactive compounds. 

In the last two decades, Atrimed group has diligently built a library of all previously published  Phyto-molecules and established a repository of real extracts from plants mentioned in  Ayurveda. Atrimed also experimented in preserving endangered plant species in tissue  culture. The virtual and real library could possibly be one be the largest in the world.

Such research necessitates the use of trans disciplinary teams to use technology from many  labs. Some examples are recombinant technology to produce target protein; molecular  biology to study biological reactions; tissue culture to study the effect of investigational  molecules on living cells. Atrimed uses computational chemistry and a docking software to  study these phytochemicals and has developed a software to predict absorption, distribution,  metabolism, excretion, and toxicity. To understand the therapeutic value of nutrition we are  developing software to see the effect of food at molecular level, which may help in  understanding the poly-pharmacology of various Ayurvedic drugs. Atrimed has also succeeded in developing plant molecules with verifiable anti-viral activity both in lab and clinical setting. 

Atrimed has collaborated with many reputed institutions. Some of them are Rajiv Gandhi  Institute of Technology, Bangalore Bio-innovations Center, Rastriya Vidyalaya College of  Engineering, Nitte center for animal studies, Nitte Gulabi Shetty Memorial Institute of  Pharmaceutical Sciences, Institute of sciences Bhubaneshwar, Regional Center of  Biotechnology Faridabad. Our company Atrimed has been awarded by Biotechnology Industry Research Assistance Council (BIRAC) and recognized by many government and  private organizations. 

The work of the Atrimed group has led to development of over one hundred effective products,  which meet international standards of safety. Some products have been retested for safety in  European labs to ensure they are free from toxic metals and pesticides. Manufactured in C GMP or FDA approved facilities, some of the products have been registered with FDA. As a  result of high-quality work, Atrimed products are selling in India and many countries abroad. 

Regulators and consumers:

The recent Ayurvedic resurgence forms but a minuscule part of  the health and wellness universe. The private and public initiatives can expand only if  enabled by the government and accepted by the global consumer. From the regulatory  authorities in becoming enablers to people becoming informed consumers, all intermediary  stake holders need to participate in rejuvenating this tradition. The regulators could help evolve the market with a multi-pronged initiative, which would  include new laws for intellectual property, new integrated medical training, funding of  original research and controlling fake claims in marketing. 

The growth of Ayurveda also requires an informed consumer who is equipped to utilize Ayurvedic or modern medicine. As many diseases are self-limiting, either one may suffice but  the decision is critical when the disease demands an expert’s help for recovery. Ideally, the  treating physician would keep the patient’s best interest foremost and guide her towards the  best available treatment. But it gets muddled due to financial incentive the physician gets by  providing treatment. In both modern and AYUSH systems, the practitioners range from  altruistic to commercial, from competent to charlatans. Perhaps the ethics of ancient  physicians are as important as modern technology. Ethical partitioners and empowered  consumers probably provide are the best guardians for reinvigorating Ayurveda.  

In our euphoria of novel discoveries, the ancient wisdom has been,  unfortunately, relegated to an inferior status because of perceived low utility. But discarding  ancient wisdom of our inheritance may be inimical to achieve the target of a healthier and happier human life. The rejuvenation of Ayurveda needs a new impetus, which integrates the  traditional intuitive method with the analytical reductionist method of western science. The  tradition of Ayurveda deserves neither derision nor worship; it needs honest investigation to  establish its validity globally.

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Dental biomaterials are largely used to replace and treat damaged or lost teeth, tooth substance, and jawbone

Dental biomaterials are largely used to replace and treat damaged or lost teeth, tooth substance, and jawbone. They are also useful for filling cavities, crowns, implants, bridges, and removable prosthetics. These materials generally include resin-based materials, ceramics, and metallic materials. In general, there are three types of dental biomaterials which are bioinert, bioactive, and biodegradabl

• Bioinert materials: These materials do not interact with the tissue or environment in which they are positioned.
• Bioactive materials: On the other hand, these materials directly interact with their surrounding environment where the material binds chemically to hard or soft tissue. These tissues are the once which induce the release of a biological substance, or those which improve the healing ability of a tissue.
• Biodegradable materials: These materials offer distinct advantages for a limited time period and generally degrade at a rate similar to tissue regeneration.

Moreover, there are five main classes of dental biomaterials that include polymers, natural materials, metals, bioceramics, and composites.

1. Polymers

This one is the largest class of biomaterials and are harvested from natural resources such as plant and animal materials or synthesized in a laboratory. Cellulose and sodium alginate are the examples of polymers derived from plant material, whereas collagen, hyaluronic acid, and heparin are the polymers derived from animals. 

Besides, polymers synthesized in a laboratory are produced by the co-polymerization of conventional monomers and they can be worked to suit almost any environment. These materials can be biocompatible, hydrophilic or hydrophobic, non-absorbable or biodegradable, and so forth. Due to their flexibility, structural changes can easily occur upon introduction to a biological environment and that’s why they are an ideal component of controlled drug release systems. Polyamides, polyethylene, and poly (D,L-lactide-co-glycolide) are some of the examples of synthetic polymers.

Natural biomaterials are classified as polysaccharide-based (cellulose, chitosan), protein-based (collagen, gelatin), and tissue-derived (decellularized heart valves, blood vessels) materials.

2. Natural materials

These materials put forward distinct advantages as compared to the synthetic materials including bio-compatibility, remodelling, and biodegradability. Natural biomaterials are classified as polysaccharide-based (cellulose, chitosan), protein-based (collagen, gelatin), and tissue-derived (decellularized heart valves, blood vessels) materials. In addition, they function at a molecular level and not the macroscopic level. But, due to their complex structure, more complex strategies often gets essential for their manipulation to attain the desired function.

3. Metals

There is archaeological evidence of gold being used in dentistry as early as 1600 BC in Egypt which suggests that metallic biomaterials have been used in medical treatment for over a century. Stainless steel, aluminium, titanium, and cobalt-chromium (Co-Cr) are some of the examples of metal biomaterials.

Biomedical applications of these materials in dentistry include dental implants, or dental prosthetics (crown, denture, and bridgework). Although the metals remain bioinert in most cases, surface modifications (such as those in dental implants) allow interaction with the biological system and make them bioactive.

4. Bioceramics

Bioceramics could be bioinert (e.g. aluminium and zirconia), or bioactive (e.g. hydroxyapatite and bioactive glass) or biodegradable (e.g. tri-calcium phosphate). In Dentistry, these Bioceramics are used for periodontal treatment, maxillofacial reconstruction, and endodontic treatment.

Composites have the ability to manipulate the manufacturing process to yield the desired material properties similar to polymers.

5. Composites

These biomaterials have two or more essential materials that are either synthetic (such as dental composite filling materials) or natural (such as bone). They may also be either particulate or fibrous, or both, in nature. Composites have the ability to manipulate the manufacturing process to yield the desired material properties similar to polymers. These can be employed in both hard and soft tissue applications.

Now, if we look at some details about the dental biomaterial market, it is supposed to grow at a CAGR of 7.52% in the forecast period 2021 to 2028 as per the Data Bridge Market Research analysis.  Here are a few key factors that are expected to boost the growth of the dental biomaterial market in the forecast period.

• Increasing prevalence of dental disorders
• Rising geriatric population,
• Rising dental tourism in developing countries,
• Rising disposable income in developing countries,
• Rising expenditure on dental and oral care,
• Growing number of dental clinics,
• Increase in adoption of novel adhesives.

Moreover, a rising shift towards newer materials and products, rising modernization, rising growth in emerging countries, and technological advancements in the healthcare sector and rising research and development activities in the market will also create new opportunities for dental biomaterials market in the forecasted period of 2021-2028.The major players in the dental biomaterials market are BIOLASE, Danaher, Inc., Institut Straumann AG, and Dentsply Sirona.

Credit: Photo by Unsplash

Composed by: “Pallavi Brahmankar works in a Market Research Company and has interest in healthcare prospects.”

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