RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA BANGALORE
ANNEXURE II
APPLICATION FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1 / NAME OF THE CANDIDATEAND ADDRESS
PERMANENT ADDRESS
/ DR. PRIYANKA.CBhartesh Homoeopathic Medical College &
Hospital, Dharwad Road,Belgaum-10
335/42,58th CROSS,3rd BLOCK
RAJAJINAGAR,
BANGALORE-560010.
2 / NAME OF THE INSTITUTION / Bhartesh Homoeopathic Medical College &
Hospital, Dharwad Road,Belgaum-10
3 / COURSE OF THE STUDY &SUBJECT / M.D.(HOM)
Repertory.
4 / DATE OF ADMISSION TO THE COURSE / 01/06/2008
5 / TITLE OF THE TOPIC / A REPERTORIAL APPROACH IN THE TREATMENT OF APHTHOUS ULCER.
6. / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY
Canker sores are small ulcer craters in the lining of the mouth that are frequently painful and sensitive. Canker sores are very common. About 20% of the population (one out of five people) have canker sores at any one time. Canker sores are also medically known as aphthous ulcers or aphthous stomatitis.
· Women are slightly more likely than men to have recurrent canker sores.
· It can occur at any age, but it is more commonly seen in teenagers.
· Genetic studies show that susceptibility to recurrent outbreaks of the sores is inherited in some patients. This partially explains why family members often share the condition.
· People whose parents have canker sores have a 90% chance of developing them early in life.
This study is a sincere effort to assess the utility of homoeopathic medicines in the treatment of aphthous ulcer and the use of repertory in selecting the appropriate similimum and compiliation of various repertories in case of aphthous ulcer.
NULL HYPOTHESIS:
Homoeopathic treatment of aphthous ulcer is effective.
6.2 REVIEW OF LITERATURE
An aphthous ulcer (aka canker sore) is a type of oral ulcer which presents as a painful open sore inside the mouth or upper throat, caused by a break in the mucous membrane. The condition is also known as aphthous stomatitis, and alternatively as "Sutton's Disease," especially in the case of multiple or recurring ulcers.1
Causes:
The exact cause of many aphthous ulcers is unknown. Factors that provoke them include stress, fatigue, illness, injury from accidental biting, hormonal changes, menstruation, sudden weight loss, food allergies, the foaming agent in toothpaste (SLS), and deficiencies in vitamin B12, iron, and folic acid. Some drugs, such as nicorandil, also have been linked with mouth ulcers. In some cases they are thought to be caused by an overreaction by the body's own immune system. Certain viruses can also cause aphthous ulcers, such as Herpes simplex.2
Signs & Symptoms:
Aphthous ulcers often begin with a tingling or burning sensation at the site of the future mouth ulcer. In a few days, they often progress to form a red spot or bump, followed by an open ulcer.
The aphthous ulcer appears as a white or yellow oval with an inflamed red border. Sometimes a white circle or halo around the lesion can be observed. The grey-, white-, or yellow-colored area within the red boundary is due to the formation of layers of fibrin, a protein involved in the clotting of blood. The ulcer, which itself is often extremely painful, especially when agitated, may be accompanied by a painful swelling of the lymph nodes below the jaw, which can be mistaken for toothache.3
Aphthous ulcers are classified according to the diameter of the lesion.
Minor ulceration.
"Minor aphthous ulcers" is the most common and least severe form of the disease. Aphthous ulcers develop in childhoodChildhood (being a child) is a broad term usually applied to the phase of development in humans between infancy and adulthood.childhood and adolescenceAdolescence (Latin adolescentia, from adolescere, to grow up) is the period of psychological, social, and physical transition between childhood and adulthood (gender-specific, manhood or womanhood).adolescence, and continue sporadically throughout life. Aphthous ulcers occur exclusively on non-keratinizedEpidermis is the outermost layer of the skin. It forms the waterproof, protective wrap over the body's surface and is made up of stratified squamous epithelium with an underlying basal lamina.keratinized, moveable mucosa, such as buccal (cheeks) and lingualThe tongue is the large bundle of skeletal muscles on the floor of the mouth that manipulates food for chewing and swallowing (deglutition). It is the primary organ of taste. Much of the surface of the tongue is covered in taste buds. The tongue, with its wide variety of possible movements, assists in forming the sounds of speech. It is sensitive and kept moist by ...lingual mucosa, the floor of the mouth, and the soft palateThe soft palate (or velum, or muscular palate) is the soft tissue constituting the back of the roof of the mouth. The soft palate is distinguished from the hard palate at the front of the mouth in that it does not contain bone.soft palate .The lesion size is between 3-10mm. The appearance of the lesion is that of an erythematous halo with yellowish or grayish color. Pain is the obvious characteristic of the lesion.
Major ulcerations.
Major aphthous ulcers have the same appearance as minor ulcerations, but are greater than 10mm in diameter and are extremely painful. They usually take more than a month to heal, and frequently leave a scar. These typically develop after puberty with frequent recurrences. They occur on moveable non-keratinizing oral surfaces, but the ulcer borders may extend onto keratinized surfaces. The lesions heal with scarring and cause severe pain and discomfort.Herpetiform aphthous ulcerations.
This is the most severe form. It occurs more frequently in females, and onset is often in adulthood. It is characterized by small, numerous, 1–3 mm lesions that form clusters. They typically heal in less than a month without scarring. Palliative treatment is almost always necessary.4Normal Structure Of Oral Soft Tissues:
The oral cavity is the point of entry for digestive and respiratory tracts. The mucous membrane of the mouth consists of squamous epithelium covering the vascularised connective tissue. The epithelium is keratinized over the hard palate, lips and gingival, while elsewhere it is non-keratinised. Mucous glands (minor salivary glands) are scattered throughout the oral mucosa. Sebaceous glands are present in the region of the lips and the buccal mucosa only. Lymphoid tissue is present in the forms of tonsils and adenoids.5
Treatment:
In majority of the patient identify any predisposing factors and discuss how these may be minimized or avoided.
Offer symptomatic treatment for pain, discomfort, and swelling, especially when ulcers are causing problems with eating.6
Remedies which are useful for this condition are
Arsenic Alb, Baptisia, Borax, Kali-chl, Merc, Merc-c, Mur-ac, Nat-m, Nux-v, Sil, Sulph, Sulph-ac can be tried
Some rubrics found in Kent J.T. repertory are
Section: Mouth
Rubric : Apthae
Subrubric : bleeding easily
Section : Mouth
Rubric : Apthae
Subrubric : Gums7
Some rubrics found in Murphys repertory are
Chapter : 48
Section : Mouth
Rubric : Aphthous
Subrubric : Bleeding easily8
Aethusa cyn, Arsenicum, Baptisia, Borax, Hydrastis, Iodum, Mercurius, Phytolacca, Staphisagaria these are few of the remedies which Lilienthal describes. 9
Prognosis:
· Minor aphthous ulcers typically heal within 10–14days without scarring.
· Major aphthous ulcers may take several weeks to heal and often leave a scar. Major ulcers occur less frequently than minor ulcers.
· Herpetiform aphthous ulcers usually heal in 10–14 days.
· Many people have infrequent recurrences (once or twice a year), but some have almost continuous disease activity10
Complications:
Mouth ulcers rarely cause any complications. Most will heal naturally with time, and those that do not can usually be treated using medication .
A mouth ulcer may be an indication of an underlying condition - but the ulcer itself will not be the cause of any illness.
The only complication mouth ulcers can cause is a bacterial infection, although this is very rare. In some cases, an infected ulcer can cause the bacteria to spread to other areas of your mouth, such as your teeth.
Possible Complications
· Cellulitis of the mouth, from secondary bacterial infection of ulcers
· Dental infections (tooth abscesses)
· Oral cancer
· Spread of contagious disorders to other people 10
6.3 OBJECTIVES OF THE STUDY:
1. To study the mode of presentation of aphthous ulcer in clinical practice.
2. To assess the effectiveness of homoeopathic medicine using application of various repertories in the treatment of apthous ulcers
3. To compile a repertory on aphthous ulcer with the aid of various repertories.
7. / MATERIALS AND METHODS
7.1 SOURCES OF DATA
The subject for this study will be taken from Bhartesh Homoeopathic Medical College &Hospital, OPD/IPD and village health camps.
7.2 METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE,(IF ANY)
Ø Patients shall be selected on the basis of inclusion, exclusion criteria, history and clinical findings. A detailed case history shall be taken by interview as per the performa prepared for the topic and necessary investigations will be done.
Ø No sampling procedure shall be adopted.
Ø All cases who have aphthous ulcer and registered between the period
October 2008 to November 2009 shall be taken for the study. All cases will be seen on the 7th day for 1st month and then every 15 days for the next 2 months.
Ø Sampling size: Minimum 30 in number.
Ø Both sex.
Ø Treatment will be on the basis of homoeopathic principles and auxillary measures when / where required.
Following are the criteria fixed for the study:
1. All patients who have aphthous ulcers in the all age group will be selected for study.
2. All clinically diagnosed cases of aphthous ulcer patients irrespective of
their sex, socio-economic status, ethnic group and occupations will be considered.
3. Nutritional deficiency causing aphthous ulcer
Following is the exclusion criteria fixed for the study:
1. Subjects with essentials active treatment for maligmancy is excluded.
2. Immuno compromised individuals.
3. Any gross pathological changes with complications with irreversible pathological changes.
4. Aphthous ulcer caused due to G.I tract diseases like crohns disease ,ulcerative colitis ,etc
Results :
· Cured
· Improved
· Not improved
7.3 DOES THE STUDY REQUIRES ANY INVESTIGATIONS TO BE CONDUCTED PATIENTS OR OTHER HUMANS OR ANIMALS?
IF SO , PLEASE. DESCRIBE BRIEFLY.
The study does not need any specific investigation but investigations will be done depending on cause of case to confirm the effect of it.
7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUION IN CASE OF 7.3?
Yes, ethical clearance has been obtained from the institution.
8. / LIST OF REFERENCES:
1. Raymond L. Barnhill, A Neil Crowson. Textbook of dermatopathology, 2nd edition, Published by McGraw-Hill Professional, 2004; 1002pp.
2. Byron J. Bailey, Jonas T. Johnson. Head & Neck Surgery- Otolaryngology. 4th edition Published by Lippincott Williams & Wilkins, 2006; 596pp.
3. Robert Ireland. Clinical Textbook of Dental Hygiene and Therapy. Reprint edition 2006; Published by Blackwell Publishing, 53pp.
4. Charles V. Mann, R.C.G.Russell, Norman S. Williams. Bailey & Love’s Short practice of surgery, revised 22nd edition, Published by ELBS with Chapman & Hall, 437pp.
5. Harsh Mohan. Text book of pathology, 4th edition, Jaypee Brothers, Medical Publishers (P)Ltd, New Delhi; 494pp.
6. Davidson, Davidson`s Principles and Practice of Medicine,20th edition, Churchill Livingstones, Edinburg, 2006; 877pp.
7. Kent J.T. Repertory of the Homoeopathic Materia Medica. 6th edition, New Delhi. B.Jain Publishers 1999, 397pp.
8. Murphy Robin ND. Homoeopathic Medical Repertory. Published by Indian Books & Periodicals Publishers, New Delhi , First reprint edition, 2004; 1422pp.
9. Lilienthal Samuel M.D. Homoeopathic Therapeutics, reprint edition 1992, New Delhi. B.Jain Publishers, 39pp.
10. http://en.wikipedia.org/wiki/Aphthous_ulcer
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9 / SIGNATURE OF CANDIDATE10 / REMARKS OF THE GUIDE
11 / NAME AND DESIGNATION OF
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE(IF ANY)
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT SECTION REPERTORY
11.6 SIGNATURE / Dr.P.A.Choudhary MD(HOM)
PROFESSOR, GUIDE,
DEPARTMENT OF REPERTORY,
BHARATESH HOMOEOPATHIC MEDICAL COLLEGE &HOSPITAL,DHARWAD ROAD, BELGAUM.
Dr. Dhanashri H. Ajgaonkar MD (HOM)
PROFESSOR, GUIDE, HOD,
DEPARTMENT OF REPERTORY,
BHARATESH HOMOEOPATHIC MEDICAL COLLEGE &HOSPITAL,DHARWAD ROAD, BELGAUM.
12 / 12.1 REMARKS OF CHAIRMAN AND
PRINCIPAL
12.2 SIGNATURE
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