Peptic ulcers are breaks in the mucosal lining of the stomach (gastric ulcers) or the proximal small intestine (duodenal ulcers). They extend through the muscularis mucosa and are typically larger than 5 mm in diameter. Ulcers smaller than this or without obvious depth are called erosions (1).

Ulcers develop when there is an imbalance between aggressive factors, such as excess gastric acid, pepsin, Helicobacter pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs), and protective mechanisms, including mucus and bicarbonate secretion, healthy prostaglandin levels, adequate mucosal blood flow, and efficient epithelial repair (1,2).The overall incidence of peptic ulcer disease has declined since the widespread use of H. pylori testing and eradication therapies, as well as the use of proton pump inhibitors (PPIs) (3,4).

However, ulcer complications remain a significant cause of hospitalisation, particularly among older adults and those taking NSAIDs, aspirin, corticosteroids, serotonin re-uptake inhibitors (SSRIs) or anticoagulant medications (5).

A peptic ulcer forms when the stomach or duodenal lining is unable to resist the intensity of digestive secretions (1,2).

Protective mechanisms include:

• Mucus and bicarbonate, forming a physical and chemical barrier against acid
• Prostaglandins, which stimulate mucus production and maintain mucosal blood flow
• Tight epithelial junctions and the capacity for rapid cellular repair

Aggressive factors include:

• Hydrochloric acid and pepsin, capable of digesting exposed mucosal tissue
• H. pylori, which disrupts mucosal integrity and alters acid regulation
• NSAIDs, which reduce protective prostaglandins
• Oxidative stress, inflammation, and local ischemia, which impair repair processes

When this balance is disrupted, the protective mucus layer thins or breaks down, exposing the underlying epithelium to acid and pepsin. These corrosive agents progressively erode the tissue, forming an ulcer that may extend through the mucosa and into the muscularis layer (2).

H. pylori infection contributes by producing urease, adhesins, and inflammatory mediators that damage the epithelium and attract neutrophils, amplifying local inflammation. Similarly, NSAIDs inhibit COX-1, reducing prostaglandin levels and making the mucosa more vulnerable to injury (6).

If an ulcer erodes into a blood vessel, gastrointestinal bleeding can occur. Deep extension into the full thickness of the wall may result in perforation, which is a medical emergency (7).

Helicobacter pylori infection

H. pylori is the leading infectious cause of peptic ulcers worldwide. Testing can be carried out using the breath test, stool antigen testing or endoscopy. Eradication reduces ulcer recurrence and lowers the risk of gastric cancer in certain populations. Prevalence varies significantly depending on age, geography, and socio-economic background (8).

NSAIDs and aspirin

These medications inhibit COX-1–mediated prostaglandin synthesis, reducing mucus and bicarbonate production and impairing mucosal blood flow. They represent the most common non-infectious cause of ulcers, especially when combined with alcohol, corticosteroids, or anticoagulants (6).

Acid hypersecretion and other causes

Conditions such as Zollinger–Ellison syndrome (gastrinoma) can lead to profound acid hypersecretion and recurrent ulcers. Less common contributors include certain medications (such as bisphosphonates or potassium chloride tablets), trauma, severe physiological stress, or infections in immunocompromised individuals (9).

The role of stress

A large prospective study found that psychological stress increased the incidence of peptic ulcers (10). Although stress is rarely a sole causative factor, it influences the digestive system in multiple ways. Acute or chronic stress can increase gastric acid output, slow gastric emptying, and reduce mucus and bicarbonate production. Stress also modulates inflammatory pathways and alters the gut–brain axis, contributing to symptom severity (10, 11).

It is important to recognise that risk is cumulative. So, for example, an older adult with H. pylori who is also taking NSAIDs and anticoagulants is at substantially higher risk compared with a younger, otherwise healthy individual.

• Burning pain in the epigastrium (12)
• Pain related to meals. Duodenal ulcer pain is usually relieved by food, and gastric ulcer pain is worsened by eating. 
• Bloating, belching, early satiety
• Nausea, indigestion

Red flags requiring referral and/or urgent medical attention (1,12)

• Vomiting blood or “coffee-ground” material
• Black or tarry stools (melena)
• Sudden severe abdominal pain
• Fainting, dizziness, or signs of shock
• Rigid or tender abdomen suggestive of perforation

Herbal treatment can support the digestive mucosa, reduce inflammation, and relieve symptoms. In conventional medicine, acid suppression with PPIs is central to ulcer healing. Looking at the root causes for a particular individual is important. If H. pylori infection is a driver, eradication therapy is indicated, and if NSAIDs are contributing, they need to be discontinued.

An herbal approach to peptic ulcers focuses on soothing inflamed mucosa, promoting repair, reducing acid irritation, supporting microbial balance, and addressing underlying triggers such as stress, diet and H. pylori infection (13,14).

Whilst there are not sufficient studies supporting the efficacy of herbal medicine to eradicate substantial H. pylori infection, many herbs can support a healthier gastrointestinal environment, reduce inflammation and can modulate bacterial load while improving symptoms (15,16).

Key herbal actions include:

• Demulcents to soothe and protect irritated mucosa. Mucilage-rich plants like marshmallow (Althaea officinalis), plantain (Plantago lanceolata), liquorice (Glycyrrhiza glabra) or aloe vera (Aloe vera), coat and soothe the digestive lining, reduce acid irritation, and support epithelial repair.
• Anti-inflammatory herbs to downregulate inflammation in the gut
• Antimicrobials to support microbial balance
• Carminatives to relieve symptoms and reduce dyspepsia
• Bitters in small doses to regulate digestion
• Nervines to reduce stress

Marshmallow (Althaea officinalis)

Marshmallow is one of the most commonly used demulcent herbs for soothing irritated or inflamed mucous membranes throughout the digestive tract. Its high mucilage content forms a soft, protective gel that coats the stomach and duodenum, helping to buffer acidity and ease the raw, burning sensations that often come with ulceration.

The root is richest in mucilage, offering deeper cooling and hydrating effects, while the leaf provides a lighter soothing action with additional anti-inflammatory qualities. A cold infusion preserves mucilage best, although it can be taken as a hot infusion too (14,17).

Calendula (Calendula officinalis)

Calendula is a gentle, yet effective vulnerary used for supporting tissue repair. Traditionally, it is applied both topically and internally, and it has a long history in European herbalism for soothing inflammation of the gastrointestinal tract (18). Its triterpenoids, flavonoids, and carotenoids contribute to anti-inflammatory, antioxidant and epithelial-repairing actions (17,18)

Calendula can help support healthy mucosal regeneration, reduce gut inflammation within the gastric or duodenal lining, modulate microbial imbalance with its antimicrobial action and help tighten atrophic mucosa through its mild astringent action. It can be taken as a tincture or an infusion, but for symptomatic and acute peptic ulcers is probably best taken as a herbal infusion, as alcohol can aggravate symptoms (17).

Liquorice (Glycyrrhiza glabra)

Liquorice is one of the most valuable herbs for ulcerated or inflamed mucosa as this action has been supported by traditional use and also several studies (19,20). It is a demulcent, adaptogenic herb with anti-inflammatory properties. It increases mucus production, prolongs the life of surface epithelial cells, and has anti-inflammatory and anti-ulcer effects (21).

Glycyrrhizin, one of its active constituents, can raise blood pressure and cause increased potassium and fluid retention when used long term in some susceptible individuals (people with established hypertension) (22). Deglycyrrhizinated liquorice (DGL) has shown promise in supporting ulcer healing and reducing dyspeptic symptoms (20). This form can be safer for long-term use in people with hypertension. Otherwise, whole liquorice is effective. Liquorice can be taken as a powder, in lozenges, tincture or as a herbal infusion. 

Meadowsweet (Filipendula ulmaria)

Meadowsweet is one of the most important traditional herbs for soothing the upper digestive tract. It is rich in salicylates, flavonoids, and tannins and it has been used for centuries in European herbal medicine to cool inflammation, regulate acidity, and protect irritated mucosa (14,17). Despite containing natural salicylates, whole-plant meadowsweet is considered gentle on the stomach, it is anti-inflammatory without causing the side effects that synthetic salicylates like aspirin can cause.

Meadowsweet can be a good choice to heal peptic ulcers, as it modulates gastric acidity, helping buffer excess acid without shutting down necessary digestive secretions (21). It protects the gastric lining while reducing inflammation. Meadowsweet can be particularly helpful to ease acid reflux symptoms (14). It pairs well with chamomile, marshmallow, plantain and calendula in treatment plans where both soothing and downregulation of acidity are required.

Chamomile (Matricaria chamomilla)

Chamomile offers a combination of anti-inflammatory, antispasmodic, carminative and nervine actions (14,17). It is soothing to the digestive tract and supports the gut–nervous system connection, making it especially valuable when stress exacerbates symptoms. It can help to reduce cramping and relieve irritation. It is a good option to take long-term a tea alongside calendula, meadowsweet and/or marshmallow to reduce gut inflammation and promote healing (21).

Plantain (Plantago major/lanceolata)

Plantain combines demulcent and gentle astringent actions, which are helpful in peptic ulceration. It also has mild antimicrobial and anti-inflammatory properties (14). Plantain can help calm irritation while toning and strengthening the mucosal lining. Its iridoid glycosides and flavonoids provide mild antimicrobial and anti-inflammatory effects (21). This herb can be used both internally and externally for wounds, ulcerations, and inflamed mucosa across the digestive tract, skin, and respiratory system (17).

The digestive lining is directly influenced by what we eat and drink, so dietary choices can support ulcer healing. To promote healing of the gastric and duodenal mucosa, it is important to avoid alcohol, coffee, smoking, and any specific symptom triggers, such as spicy food and acidic tomato-based sauces (23). Eating small, regular meals is recommended. A meta-analysis has shown that Lactobacillus and Bifidobacterium strains modestly improve H. pylori eradication rates and reduce treatment-related side effects (24). They support microbial balance, motility and symptom control.

Supporting the nervous system is also an important part of the management of peptic ulcers (25). Prioritising good-quality sleep and incorporating stress reduction techniques such as mindfulness, breathing practices, and restorative movement can improve symptom severity and overall recovery.

1. Sverdén E, Agréus L, Dunn JM, Lagergren J. Peptic ulcer disease. BMJ. 2019;367. https://doi.org/10.1136/bmj.l5495 
2. Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. Lancet. 2009;374(9699):1449-1461. https://doi.org/10.1016/s0140-6736(09)60938-7 
3. Chen YC, Malfertheiner P, Yu HT, et al. Global prevalence of Helicobacter pylori infection and incidence of gastric cancer between 1980 and 2022. Gastroenterology. 2024;166(4):605-619. https://doi.org/10.1053/j.gastro.2023.12.022 
4. Azhari H, King JA, Coward S, et al. The global incidence of peptic ulcer disease is decreasing since the turn of the 21st century: a study of the Organisation for Economic Co-operation and Development (OECD). Am J Gastroenterol. 2022;117(9):1419-1427. https://doi.org/10.14309/ajg.0000000000001843 
5. Higham J, Kang JY, Majeed A. Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency of haemorrhage among older subjects. Gut. 2002;50(4):460-464. https://doi.org/10.1136/gut.50.4.460 
6. Papatheodoridis GV, Archimandritis AJ. Role of Helicobacter pylori eradication in aspirin or non-steroidal anti-inflammatory drug users. World J Gastroenterol. 2005;11(25):3811. https://doi.org/10.3748/wjg.v11.i25.3811 
7. Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. BMJ. 2019;364. https://doi.org/10.1136/bmj.l536 
8. Hooi JK, Lai WY, Ng WK, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153(2):420-429.
9. Rossi RE, Elvevi A, Citterio D, et al. Gastrinoma and Zollinger Ellison syndrome: a roadmap for the management between new and old therapies. World J Gastroenterol. 2021;27(35):5890. https://doi.org/10.1053/j.gastro.2017.04.022 
10. Levenstein S, Rosenstock S, Jacobsen RK, Jorgensen T. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol Hepatol. 2015;13(3):498-506. https://doi.org/10.1016/j.cgh.2014.07.052 
11. Deding U, Ejlskov L, Grabas MPK, Nielsen BJ, Torp-Pedersen C, Bøggild H. Perceived stress as a risk factor for peptic ulcers: a register-based cohort study. BMC Gastroenterol. 2016;16(1):140. https://doi.org/10.1186/s12876-016-0554-9 
12. National Institute of Diabetes and Digestive and Kidney Diseases. Peptic ulcers (stomach ulcers): symptoms & causes. https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/symptoms-causes. Accessed [date].
13. Tiwari D, Alam A, Dhoundiyal S, Sharma S, Yadav S. Medicinal herbs for the treatment of peptic ulcers. Curr Tradit Med. 2024;10(7):106-118.
14. McIntyre A. The Complete Herbal Tutor: The Definitive Guide to the Principles and Practices of Herbal Medicine. Aeon Books; 2019.
15. Shmuely H, Domniz N, Yahav J. Non-pharmacological treatment of Helicobacter pylori. World J Gastrointest Pharmacol Ther. 2016;7(2):171. https://doi.org/10.4292/wjgpt.v7.i2.171 
16. Safavi M, Shams-Ardakani M, Foroumadi A. Medicinal plants in the treatment of Helicobacter pylori infections. Pharm Biol. 2015;53(7):939-960. https://doi.org/10.3109/13880209.2014.952837 
17. Fisher C. Materia Medica of Western Herbs. Aeon Books; 2018.
18. Ejiohuo O, Folami S, Maigoro AY. Calendula in modern medicine: advancements in wound healing and drug delivery applications. Eur J Med Chem Rep. 2024;12:100199.
19. Rahnama M, Mehrabani D, Japoni S, Edjtehadi M, Firoozi MS. The healing effect of licorice (Glycyrrhiza glabra) on Helicobacter pylori infected peptic ulcers. J Res Med Sci. 2013;18(6):532.
20. Khorasani EZ, Amirian T, Formi EN, Mahjoub F, Sadeghi M. Efficacy of Glycyrrhiza glabra on peptic ulcer disease: a systematic review and meta-analysis. Adv Integr Med. 2025;12(4):100485.
21. Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Elsevier Health Sciences; 2013.
22. Penninkilampi R, Eslick EM, Eslick GD. The association between consistent licorice ingestion, hypertension and hypokalaemia: a systematic review and meta-analysis. J Hum Hypertens. 2017;31(11):699-707. https://doi.org/10.1038/jhh.2017.45 
23. Marotta RB, Floch MH. Diet and nutrition in ulcer disease. Med Clin North Am. 1991;75(4):967-979.
24. Wang ZH, Gao QY, Fang JY. Meta-analysis of the efficacy and safety of Lactobacillus-containing and Bifidobacterium-containing probiotic compound preparation in Helicobacter pylori eradication therapy. J Clin Gastroenterol. 2013;47(1):25-32. https://doi.org/10.1097/mcg.0b013e318266f6cf 
25. Levenstein S. Stress and peptic ulcer: life beyond Helicobacter. BMJ. 1998;316(7130):538. https://doi.org/10.1136/bmj.316.7130.538 

Ayurveda is the ancient Indian system of healthcare and longevity. For an in depth history, find our article, A history of Ayurveda and the growth of the Materia Medica. Ayurveda’s holistic approach to oral health emphasises the connection between oral wellness and overall body health. Ayurveda has always viewed the mouth as both a gateway to and reflection of health — being the primary entry point for pathogens. The link between oral health problems and systemic diseases like diabetes and cardiovascular disorder is now widely recognised. Numerous studies reveal a strong connection between certain pathogenic microbes in the mouth and multiple health conditions including diabetes, Alzheimer’s, heart disease, inflammatory conditions, and autoimmune disorders (1). For example, oral bacteria can enter the bloodstream and trigger arterial plaque, increasing the risk of heart conditions (2). 

This broad-spectrum approach aims to treat the root causes of oral health problems rather than just addressing symptoms. There is a great need for such an approach as currently in the  UK, oral health issues are highly prevalent, with various statistics indicating significant challenges (3): 

• 39% of adults do not visit the dentist regularly
• 66% of adults have visible plaque
• 31% of adults have tooth decay

Globally, oral diseases, while largely preventable, pose a major health burden for many countries and affect people throughout their lifetime, causing pain, discomfort, disfigurement and even death. The WHO estimate that oral diseases affect nearly 3.7 billion people. Untreated dental caries in permanent teeth is the most common health condition according to the Global Burden of Disease 2021. Most low- and middle-income countries do not have sufficient services available to prevent and treat oral health conditions (4). Holistic health practitioners can play a key role in empowering clients with knowledge about their health and lifestyle choices, as well as helpful herbs to support oral health. 

How does oral health work according to Ayurveda?

Ayurveda, with its wisdom going back thousands of years, offers profound insights into maintaining oral hygiene and preventing dental ailments. Oral health is known as danta swasthya in Ayurveda, with danta being the Sanskrit word for tooth. This topic is covered in the key Ayurvedic classical texts of both Charaka and Sushruta Samhita, Astanga Samgraha of Vagbhata and the Kasyapa Samhita, the most extensive acharya of the field with a separate chapter on dentation. According to the Sushruta Samhita, fifteen diseases of the roots of the teeth and gums have been mentioned, along with eight of the teeth (5). 

Normal healthy teeth are strong, white, smooth without decay. The gums should be even, pink and smooth. Teeth are considered a byproduct (updadhatu) of bone tissue (asthi dhatu), along with hair and nails. Hence, the health of teeth and nails can be seen as an indicator of the health of underlying bone tissue (6). It is mentioned that the tooth eruption (dantopatti kala), commonly referred to as teething, is best when a child is eight months old. Delayed teething is seen as due to decreased bone tissue. Receding gums and weak teeth in adults are also seen as due to this cause, versus extra teeth being seen with increased bone tissue.

A recent study looked at the association between dental health and osteoporosis in South Indian women with findings that individuals with osteoporosis are more likely to have poor oral health, with cavities and tooth loss being their main issues. Tooth loss may thus be used as a surrogate marker to predict osteoporosis (7).

Hence, food and herbal tonics that are good for bones and the muscular tissues are also beneficial for teeth and gums. To prevent tooth and gum disease good oral hygiene should be implemented in our daily routine (dinacharya) covered below. Indeed, most oral health conditions are largely preventable and can be treated in their early stages, such as dental caries (tooth decay), periodontal diseases, tooth loss and oral cancers. 

Although Western medicine has only recently discovered the correlation between oral health and systemic health, Ayurveda has long recognised the importance of oral health. The mouth is considered the mukha, or opening, to three of the sixteen main channels (srotamasi) of the body; specifically, the digestive tract (anna vahasrotas), the respiratory tract (prana vahasrotas), and the water channel (ambu vahasrotas).  

As the origin of these vital channels, it is not too surprising that imbalances in the mouth will lead to imbalances over time. This correlation stems from pathogenic microbes that are present in periodontitis spreading throughout the system (via the lungs, digestive tract, bloodstream, etc.) leading to issues such as systemic inflammation, plaque in the brain, plaque in the arteries, and increased blood sugar levels.  Ayurveda uses the mouth as a window into the total health of an individual, with use of tongue analysis (along with traditional Chinese medicine), which involves reading the tongue to indicate disorders of the doshas, digestion and even emotions. 

Each of these is described with detailed symptoms, causes, and personalised treatment approaches based on Ayurvedic philosophy. Problems such as deformities of the oral cavity, plaques and infections were managed in ancient India. According to Ayurveda, particularly the branches of shalyatantra (surgical science) and shalakyatantra (ENT and dentistry), there are 65 types of oral diseases, which arise from imbalances in the body and can manifest in seven anatomical locations (8):

• Lips: Eight types of diseases
• Gums: 15 types
• Teeth: Eight types
• Tongue: 5 types
• Palate: Nine types
• Throat: 17 types
• Generalised oral issues: Three types

The health of our mouth is directly linked to the overall balance of our doshas: vata, pitta, and kapha. An imbalance can lead to various oral issues. Broadly, tooth decay and cavities, excess mucus, plaque and swelling are associated with an excess of kapha dosha, which results in an overproduction of mucus or plaque. Gum inflammation, ulcers, bad breath and bleeding is linked to an imbalance in the pitta dosha, often caused by excessive heat or acidity in the body. Tooth sensitivity, pain, dryness and receding gums are typically signs of a vata imbalance, where there is a disruption in the nervous system and circulation. 

The mouth, being the beginning of the digestive system, is also linked to the health of our digestive fire, or agni. A healthy agni ensures proper digestion and absorption, reducing the chances of oral issues. The oral microbiome contains about 700 various species of microbes making it the largest microbiome aside from the gut. Around 45% of the microbes in the mouth can also be found in the gut suggesting a strong connection between our oral health and our digestive health (9).  With a direct route to your digestive tract, the pathogenic microbes in your mouth can easily find a home in the GI tract, triggering inflammatory GI disorders, gut dysbiosis, and other digestive disturbances.

Ayurveda emphasizes individualised care, which is determined by a person’s unique physical and mental constitution (prakriti). This approach takes into account:

• Dominant doshas (vata, pitta and kapha)
• Seasonal and climatic changes
• Diet, digestion and lifestyle
• Tailored herbal prescriptions

The Ayurvedic approach to oral health looks at both addressing symptoms as well restoring balance to the microbiome and bone tissue regeneration (asthi dhatu support) on a deeper level. There is a need to balance the body’s doshas, cleanse tissues and support the natural production of healthy saliva. Indeed, Ayurveda recognizes saliva as the mouth’s protective shield (kavalagraha) which naturally remineralises enamel, neutralises acidity and maintains a pH-balanced oral environment to suppress harmful bacteria. 

Some common oral health issues include:

• Grinding of the teeth: Grinding of teeth is often related to stress or anxiety. It may indicate deep seated anger and fear, according to Dr Vasant Lad, and vitiation of the bone tissue (6).
• Sensitivity: Affects over a third of adults, often caused by brushing too hard or consuming acidic foods.
• Bleeding gums (gingivitis): Affects a third of adults, typically a sign of gum disease. 
• Tooth decay: Caused by poor oral hygiene and sugary foods, requiring regular brushing and flossing. 
• Gum disease: Inflammation of the gums, often reversible with good oral care. 
• Dental abscesses: Infections that can occur due to untreated dental issues.

It is always recommended to consult a qualified herbalist or Ayurvedic practitioner to determine the most suitable herbs, correct dosage and best method to take for oral health issues.

Allopathic medicine has had only limited success in the prevention of periodontal disease and in the treatment of a variety of oral diseases. Hence, the search for alternative products continues and natural phytochemicals isolated from plants used in traditional medicine are considered effective alternatives to synthetic pharmaceuticals. The herbs in the Ayurvedic material medica have been proven to be safe and effective, through several hundred to several thousand years of use (10).

Amla (Phyllanthus emblica)

Amla is a highly esteemed Ayurvedic herb with powerfully protective and adaptogenic properties, with high levels of vitamin C (20 times greater than an orange). It is widely used for cardiovascular and cellular health, offering support to the immune system and in metabolic disorders. It is renowned in Ayurveda as a rejuvenative tonic, or rasayana, and an adaptogen which has the ability to restore vigour and vitality. Its name in Sanskrit means ‘the sustainer’, and it is traditionally used to provide nourishment to all of the body’s tissues. It specifically promotes rejuvenation and tissue regeneration throughout the oral cavity, thanks to its astringent and bitter tastes. Amla also works well as a mouth rinse as a decoction. 

Clove (Syzygium aromaticum)

Clove has been used for thousands of years as both food and medicine.  Clove has a strong reputation as a local anodyne (pain reliever) for dental pain. It is often used in powdered form or as a diluted pure essential oil applied directly onto the affected gum. Essential oils are powerful substances and must be used with caution, so follow advice for the correct application of clove for dental pain. Looking more broadly, due to its anti-fungal effects clove may be used as part of a treatment approach to tackle Candida albicans . It has a wide range of antibacterial and anti-fungal actions which may make it a useful herb for associated dysbiotic conditions in the gastrointestinal tract (11).

Khadira (Acacia catechu)

Khadira (Acacia catechu) is highly astringent as its bark is rich in tannins, so it tightens loose gums and stops bleeding. This is especially helpful with gingivitis. Traditional khadira manjan (tooth powder) cleans teeth and leaves a refreshing, earthy aftertaste.  

Neem (Azadirachta indica)

Neem supports dental and gum health through its potent antibacterial, anti-inflammatory, antifungal, and astringent properties, making it a key herb for preventing plaque, gum disease, cavities, and bad breath while promoting whiter teeth and healthier gums. It contains two chemical constituents known as azadiractin and nimbin which are responsible for its antibacterial, antifungal and anti-inflammatory activities. Neem twigs were traditionally used as a toothbrush, alongside rinsing with neem decoction made from boiling up the leaves. 

Liquorice root (Glycyrrhiza glabra)

Liquorice is valued for its natural antimicrobial, anti-inflammatory, and soothing properties that help maintain healthy teeth and gums and reduce oral infections. It contains the glycyrrhizin and flavonoids that inhibit the growth of harmful oral bacteria. Its ability to calm inflammation and soothe irritated gum tissues can help alleviate symptoms of gingivitis. 

Regular use in oral hygiene routines strengthens gums, while also supporting the healing of mouth ulcers due to its regenerative properties. It is often used in herbal tooth powders, pastes, or mouth rinses. Chewing on a small piece of liquorice root is also a traditional practice to naturally clean teeth and freshen breath.

Triphala (Terminalia chebula, T. belerica and Emblica officinalis)

Triphala is a blend of three fruits which is suitable for everyone, as each fruit balances one of the doshas. Its role as a deep tissue cleanser is reflected in its possessing five of the six Ayurvedic tastes, each with traditional medicinal qualities. Its astringent taste is especially helpful in reducing gum inflammation. It regenerates all digestive mucosal membranes, including in the mouth.

It has been widely researched for oral health applications  and has also been shown to promote beneficial Bifidobacteria and Lactobacillus, while inhibiting undesirable microbes (12). Its tannins and phenolic compounds are thought to be largely responsible for these positive effects, comparable to chemical agents like chlorhexidine, but without side effects like tooth staining. It is now a respected natural oral care remedy in Ayurveda and modern herbal dentistry alike (13).

Turmeric (Curcuma longa)

Turmeric is both one of the most extensively used spices in the world and the most researched, with clinical evidence to support its potent anti-inflammatory properties. Its key compound, curcumin, helps reduce gum inflammation, alleviates gingivitis, and soothes swollen or bleeding gums by modulating the immune response. Its natural antimicrobial qualities inhibit harmful bacteria and fungi in the mouth, maintaining balanced oral microbiota. Traditional Ayurvedic practices use turmeric in homemade tooth powders, mouth rinses, or as a paste for massaging gums. Mixing turmeric with salt or neem powder is common to enhance its oral hygiene benefits.

A study compared a chlorhexidine mouthwash with a triphala mouthwash and a curcumin mouthwash. Both were proven to be equally effective in reducing plaque, gingival and bleeding scores, although the curcumin was better in reducing gingival inflammation. Hence, herbal mouthwashes such as triphala and curcumin with no side effects can be considered as an alternative mouthwash to chlorhexidine (14).

Please note: If you are not getting relief with these remedies then consult your doctor and your herbal practitioner. If there are any serious underlying health conditions, or if one is taking pharmaceuticals, it is important to check for interactions. It is best to consult a qualified clinical herbalist or doctor for this.

Ayurveda also places great emphasis on preventative health through daily routines to preserve oral health and prevent disease.

Diet support

• Keep digestion strong: A strong digestive fire means a healthy gut microbiome and less toxins overall; both important factors for supporting oral health. Chewing food well in the mouth is very helpful. Digestive issues such as hyperacidity or acid reflux can also lead to oral health issues as well including receding gums, cavities, demineralization, and inflammation.
• Sipping warm water throughout the day:  This supports general digestion, gently cleansing and promoting oral health. It also keeps the mouth hydrated which will create a less acidic environment, supporting healthy bacteria. 
• Avoid drinking sweet drinks and snacking between meals: This releases acids that lower the pH of your mouth more frequently than nature intended. The continuous state of a lower pH promotes dysbiosis (flora imbalance) in the mouth leading to cavities, demineralisation, bad breath, receding gums, inflammation, and infections.  Snacking is also seen to upset the digestive fire (agni).
• Limit sugar, refined grains, and processed foods: Sweets, refined grains, and processed foods support inflammation and weakened immunity, which also play a role in oral health issues. Include foods such as ghee, milk, buttermilk and rice, which build strength (known as ojas in Ayurveda). Minimise spicy, salty and acidic foods

Lifestyle suggestions 

These simple, holistic traditional practices could be widely incorporated into primary care, based on centuries of safe use (15):

Daily use of tongue scraper (jivha Lekhana)

The tongue harbours bacteria, plaque, and oral debris that the tongue scraper clears away. Scraping first thing each morning reduces bad odour and improves the taste sensation. A thin, slightly white, and moist coating is normal and indicates good digestion.  Ideally this is made of silver or copper which has antibacterial properties and does not rust, or stainless steel. A toothbrush is not recommended for this job as it may damage tastebuds. Avoid plastic tongue scrapers which tend to harbour unwanted bacteria and contain unwanted chemicals.  

Studies have shown that this practice reduces Streptococcus mutans and Lactobacillus, both known to cause decay. In a study of sixty men, patients were advised to use a tongue scraper twice daily for at least two minutes for seven days. No effort was made to change tooth brushing or dietary habits of patients. This had a significant effect on bacteria and also decreased oral malodour (16).

Gargling (gandusha and kavala)

Oil pulling is a traditional oral health practice that dates to around 5000 BCE, as detailed in ancient Ayurvedic texts, particularly the Charaka Samhita. In gandusha, the mouth is filled with oil and held for 3–5 minutes without movement, then released. In kavala, a comfortable amount of oil is swished and gargled for a few minutes — sesame oil and coconut oil are preferred. This helps maintain good oral hygiene, ensuring any food debris lodged in the teeth is expelled out when the oil is spit out. These oils also have antibacterial properties.

The lubricating effect relaxes irritated throat tissues and keeps the mouth moist. Regularly doing gandusha can also help in strengthening the facial muscles. It is best done early in the morning. Once finished, spit out the oil. It is very important not to swallow it. Rinse the mouth with warm water then brush teeth, floss, and use a tongue cleaner as usual.

Triphala mouthwash

The ingredients in your toothpaste and mouthwashes will have a positive or negative effect on your oral microbiome health and can have systemic effects such as parabens, triclosan, sodium lauryl sulphate (SLS) and saccharin (17). Conventional mouthwashes contain many harsh ingredients — for your body and the environment. Hence the warnings not to swallow them. They are also very strong, especially the ones containing alcohol.

Research shows that triphala is equally effective to conventional mouthwashes in reducing and preventing plaque, gingivitis, and bacteria known to cause tooth decay, without being excessively harsh (18). To make a triphala mouthwash, simply mix ½ teaspoon of triphala powder with ½ cup of warm water and use as a mouthwash each evening. Alternatively make up a triphala decoction for several days use. 

Brushing of the teeth (danta dhavana)

Before the advent of toothbrushes, people in India used neem twigs to brush their teeth. The stick should be chewed until it is broken up. Neem contains powerful antibacterial, antifungal and anti-inflammatory compounds which help in reducing plaque and preventing cavities. Other sticks recommended come from the Banyan, Khadira, or Arjuna tree — all astringent, heating and bitter in taste.

Research has shown all kinds of chewing sticks described in ancient Ayurveda texts have medicinal and anti-cariogenic properties (14). The taste of the stick helps to clear mucous secretions in the mouth. Today, this practice is less common with tooth brushes being prevalent, but these should have soft bristles. Try to avoid adding pressure while brushing. 

Rinsing the mouth with water after each meal

This is a traditional Indian folk practice, aimed at expelling the food residue left behind in the pockets of the mouth after eating.  A surprising amount of food particles can be released in this simple way. 

Herbal tooth powders / oils

The teachings of Ayurveda say that toothpaste should be astringent and bitter in taste, as sweet toothpaste causes the saliva to become thick leading to the development of tartar. Neem, triphala and tea tree are all seen as desirable in toothpastes.  A pinch of turmeric and salt can also be mixed to form a natural toothpaste that combats inflammation and infections. A pinch of salt in mustard oil can also be gently massaged onto the gums. Finally, clove oil can be applied to a painful tooth as a natural anaesthetic. Chewing on cloves also helps in reducing bad breath.  

Reduce teeth grinding (bruxism)

Stress is a known cause of bruxism, which weakens enamel causing and may even cause broken teeth.  It can be prevented or reduced through stress-relieving therapies to soothe the nervous system, especially before bed (if teeth grinding is a nighttime issue). Oil pulling and massaging the jaw area, especially directly under the ears with a soothing oil can also help prevent teeth grinding.  A traditional Ayurvedic home remedy is to chew half a teaspoon of uncooked basmati rice before bedtime, then, brush teeth and hold a mouthful of warm sesame oil for five minutes in the mouth. Leave a little oil in the mouth before going to bed (6).

1. Jenkinson HF, Lamont RJ. Oral microbial communities in sickness and in health. Trends Microbiol. 2005;13(12):589-595. https://doi.org/10.1016/j.tim.2005.09.006
2. Medical News. The surprising link between gum disease and heart problems. Published March 28, 2019. Accessed September 15, 2025. https://medical-news.org/the-surprising-link-between-gum-disease-and-heart-problems/112997
3. UK Health Security Agency. Adult oral health survey 2021: self-reported health of teeth and gums. GOV.UK. Published August 10, 2023. Accessed September 15, 2025. https://www.gov.uk/government/statistics/adult-oral-health-survey-2021/adult-oral-health-survey-2021-self-reported-health-of-teeth-and-gums
4. World Health Organization. Oral health. WHO fact sheet. Updated March 16, 2022. Accessed September 15, 2025. https://www.who.int/news-room/fact-sheets/detail/oral-health
5. Sushruta. Sushruta Samhita. Vol 2, Nidanasthana, Chapter 16. (Classical Sanskrit Surgical Text).
6. Lad V. Textbook of Ayurveda, Vol 1: Fundamental Principles. Albuquerque, NM: Ayurvedic Press; 2002:150-153.
7. Kapoor N, Cherian KE, Pramanik BK, et al. Association between dental health and osteoporosis: a study in South Indian postmenopausal women. J Midlife Health. 2017;8(4):159-162. https://doi.org/10.4103/jmh.JMH_21_17
8. Chakravorty RC. Head and neck diseases in an ancient Indian surgical text (The Sushruta-samhita). Med Hist. 1971;15(4):393-396. https://doi.org/10.1017/s002572730001694x
9. Olsen I, Yamazaki K. Can oral bacteria affect the microbiome of the gut? J Oral Microbiol. 2019;11(1):1586422. https://doi.org/10.1080/20002297.2019.1586422
10. Torwane NA, Hongal S, Goel P, Chandrashekar BR. Role of Ayurveda in management of oral health. Pharmacogn Rev. 2014;8(15):16-21.
11. Pole S. Ayurvedic Medicine: The Principles of Traditional Practice. London: Singing Dragon; 2013.
12. Kumar A, Banswal S. Therapeutic uses of Triphala in traditional Indian medicine and its interaction with the gut microbiome. Research Publish. Published February 6, 2025. Accessed September 15, 2025. https://www.researchpublish.com/upload/book/Therapeutic%20Uses%20of%20Triphala-06022025-1.pdf
13. Nair SK, Shivaprasad BM. Triphala: a miracle herb in the field of dentistry. J Dent Health Oral Disord Ther. 2018;9(1):00320. Accessed September 15, 2025. https://medcraveonline.com/JDHODT/triphala-a-miracle-herb-in-the-field-of-dentistry.html
14. Bharathi SD, Aiswarya SP, Sankar AR. Comparative evaluation of the efficacy of Triphala mouthwash and curcumin mouthwash in the treatment of gingivitis—a randomized controlled study. J Oral Biol Craniofac Res. 2024;14(4):407-414. https://doi.org/10.1016/j.jobcr.2024.05.002
15. Singh A, Purohit B. Tooth brushing, oil pulling and tissue regeneration: a review of holistic approaches to oral health. J Ayurveda Integr Med. 2011;2(2):64-69.
16. Almas K, Al-Sanawi E, Al-Shahrani B. The effect of tongue scraper on mutans streptococci and lactobacilli in patients with caries and periodontal disease. Odonto-Stomatol Trop. 2005;28(109):5-10. https://pubmed.ncbi.nlm.nih.gov/16032940/
17. Vranic E, Lacevic A, Mehmedagic A, Uzunovic A. Formulation ingredients for toothpastes and mouthwashes. Bosn J Basic Med Sci. 2004;4(4):51-58. https://doi.org/10.17305/bjbms.2004.3362
18. Bajaj N, Tandon S. The effect of Triphala and chlorhexidine mouthwash on dental plaque, gingival inflammation, and microbial growth. Int J Ayurveda Res. 2011;2(1):29-36. https://doi.org/10.4103/0974-7788.83188