RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BENGALURU, KARNATAKA.
SYNOPSIS BY
Dr. RASHMI C. SUVARNA
FOR THE DEGREE OF AYURVEDA DHANWANTARI
M.S. (AYURVEDA) IN SHALAKYA TANTRA
TITLE OF THE DISSERTATION
“A STUDY ON THE EFFICACY OF LEKHANA KARMA FOLLOWED BY LAKSHADI PRATISARANA, KAVALA AND NASYA IN THE MANAGEMENT OF UPAKUSHA.”
NAME OF THE INSTITUTE
GOVERNMENT AYURVEDIC MEDICAL COLLEGE,
DHANWANTARI ROAD,
BENGALURU – 09,
KARNATAKA.
From,
Dr. RASHMI.C.SUVARNA
I M.S, Dept of Post Graduate Studies in Shalakya tantra,
Government Ayurvedic Medical College,
Bengaluru – 560009
To,
THE REGISTRAR,
Rajiv Gandhi University of Health Sciences,
Bengaluru – 560041
Through,
THE PRINCIPAL AND H.O.D OF POST GRADUATE G.A.M.C STUDIES IN SHALAKYA
Bengaluru – 560009, TANTRA
G.A.M.C, Bengaluru-560009 Respected sir,
Sub:- Submission of completed proforma for registration of
subject for Dissertation
I request you to kindly register the below mentioned subject against my
name for the submission of dissertation to the Rajiv Gandhi University of
Health Sciences, Bengaluru for the partial fulfillment of MS (Ayu)(ShalakyaTantra).
TITLE OF DISSERTATION:
“A STUDY ON THE EFFICACY OF LEKHANA KARMA FOLLOWED BY LAKSHADI PRATISARANA, KAVALA AND NASYA IN
THE MANAGEMENT OF UPAKUSHA.”
Herewith I am enclosing completed proforma for registration of subject for
Dissertation work.
Thanking you,
Yours sincerely,
Place: Bengaluru
Date:
(Dr Rashmi C .Suvarna)
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BENGALURU, KARNATAKA.
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND RESIDENTIAL ADDRESS/ Dr RASHMI C.SUVARNA.
D/O B.K.CHANDRASHEKAR
AMIN NIVAS, S.KODI,
KINNIGOLI, MANGALORE-574179.
DAKSHINA KANNADA,
KARNATAKA.
2. / NAME OF THE INSTITUTION / GOVERNMENT AYURVEDA MEDICAL COLLEGE,
DHANWANTARI ROAD,
BENGALURU-09.
3. / COURSE OF STUDY AND SUBJECT / AYURVEDA DHANWANTARI.
M.S. (AYU), SHALAKYA TANTRA.
4 /
DATE OF ADMISSION TO THE COURSE
/ 29/10/20115. / TITLE OF THE TOPIC OF DISSERTATION:
“A STUDY ON THE EFFICACY OF LEKHANA KARMA
FOLLOWED BY LAKSHADI PRATISARANA, KAVALA AND NASYA
IN THE MANAGEMENT OF UPAKUSHA.”
6 . BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY
Mukha is considered as one of the most important part of urdhwajatru, because it is the reflection of the body health as it is the gateway of alimentary canal. Fast food culture, unhealthy habits like smoking and improper oral hygiene have caused irreversible damage to oral and general health.
Earliest reference about Upakusha is available in Sushruta samhita (2350B.C.). He has mentioned it under Danta moolagata rogas in mukharoga prakarana. Upakusha results in burning sensation, halitosis, redness, swelling and bleeding of gums leading to tooth mobility. Clinically Upakusha shows similarity with Periodontitis. As per the statistics of Indian population the incidence of periodontal disease is 45% of the total oral diseases (IDA 2001).
Periodontitis is defined as “an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms, resulting in progressive destruction of periodontal ligament and alveolar bone with increased probing depth formation, recession or both. The disease causes mental distress to the person mainly due to foul smell, pus discharge, gingival bleeding and tooth mobility. It is more often caused by dental plaque. Lack of proper oral hygiene and untimely treatment leads to its chronicity.
Management of periodontitis according to modern dentistry is mechanical removal of Plaque by scaling, chlorhexidine mouth wash, root planning and flap surgery which are quite expensive and cause lot of inconvenience to the patients.
The need here is to identify the disease in the early stage and treat the disease so as to prevent the progression and reduce recurrence as far as possible. So an effective and less expensive and convenient treatment for Upakusha is essential. One of the treatment lines described in our classics for Upakusha are Vilekhana, Lakshadi Pratisarana, Yashtimadhu ghrita Kavala and Nasya. The ingredients of the preparations are easily available, cost effective, easy to prepare and administer. Considering the above factors, this study has been taken up to evaluate its efficacy in the management of Upakusha.
6.2 REVIEW OF LITERATURE
UPAKUSHA
MUKHA ROGA NIDANA AND SAMPRAPTI
Meat of fish, buffalo and boar, uncooked mulaka, soup of masha, curds, milk, sukta
[fermented gruel], juice of sugarcane and phanita [ half cooked molasses], sleeping in prone position, not cleaning the teeth daily, improper administration of therapies like inhalation, emesis, mouth gargles and venesection etc by these causes aggravation of doshas with the predominance of sleshma and produce diseases inside the mouth.1(Us.Ch.21 Sl 1-2. p184)
(Us.Ch.21 Sl 1- 2. p184)
LAKSHANA
Upakusha is ulceration arising from (aggravation of ) pitta and asrk (blood), the gums have burning sensation, are red, swollen, itching; exude blood, gets distended after the bleeding stops; teeth are shaky, slightly painful and the mouth emits bad odour.1(Us.Ch21 Sl.21,22.p188)
(Us. Ch.21 Sl. 21,22. p188)
CHIKITSA
In Upakusha, the gums should be fomented by holding hot water in the mouth and then scraped many times either with mandalagra shastra(lancet) or leaves of shaka tree; next the paste of laksha, priyangu, pattanga, lavanottama, gairika, kushta, shunti, maricha, yashtimadhu and rasanjana added with scum of ghee and honey should be rubbed; then either scum of the ghee or oil should be held in the mouth lukewarm; ghee prepared with drugs of sweet taste is beneficial both for holding in mouth and nasal medication.1(Us.Ch.22 Sl.29-32.p203)
(Us.Ch.22 Sl.29-32.p203)
MODERN VIEW
Periodontitis is defined as “an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of periodontal ligament and alveolar bone with increased probing depth formation, recession, or both”. It has following features –supragingival and subgingival plaque accumulation(frequently associated with calculus formation), gingival inflammation, pocket formation, loss of periodontal attachment, loss of alveolar bone, and occasional suppuration, bleeding gums on brushing or probing, teeth mobility, halitosis, localized dull pain, gingival tenderness or itchiness.2(p.160)
ETIOLOGY
Local factors
1. Micro organisms
2. Plaque accumulation
3. Food impaction
4. Faulty restorations of dental appliances
5. Smoking.
6. Tooth malposition
Systemic factors
1. Nutritional deficiency- vitamins, minerals, protein.
2. Endocrine changes associated with Diabetes mellitus and Pregnancy.
3. Hematological disorders like leukemia, nuetropenia, sickle cell anaemia.
4. Genetic disorders like Down’s syndrome, Infantile genetic agranulocytosis.
5. Immunopathies- immune deficiency disorders-HIV.
6. Metal intoxication like mercury, phosphorus, arsenic.2(p.163)
TYPES
Depending on the onset 1.Chronic adult periodontitis .
2. Aggressive.
3. Refractory/recurrent.
Depending on the distribution 1. Localized 2.Gereralised
Depending on the severity 1. Mild or slight.
2. Moderate.
3. Severe.3(p.241)
TREATMENT
1. Phase 1 Therapy (Etiotrophic Phase)
a) Plaque control.
b) Removal of calculus and root planning.
c) Correction of restorative and prosthetic irritational factors.
d) Anti microbial therapy.
2. Phase 2 Therapy (Surgical phase).
a) Periodontal surgery including placement of implants.
b) Root canal treatment
3. Phase 3 Therapy (Restorative phase)
a) Final restorations.
b) Fixed and removable prosthodontics.
4. Phase 4 Therapy (Maintenance phase)
a) Periodic recall visits.
b) Checking for plaque and calculus.
c) Gingival condition (Pockets, inflammation).
d) Occlusion, tooth mobility and other pathologic changes.3(p.267)
ABBREVATIONS
Us- Uttara sthana
Ch- chapter
Sl- sloka
p- page number
PREVIOUS DISSERTATIONS WORKS DONE
1. Dr. Preeti - Clinical study on Upakusha and its management with special reference to shodhana and sthanika upakramas- GAMC Bangalore 2003-04
2.Dr. Radhika K. Varma- A clinical study on the comparative efficacy of topical medicines Vs oral medication in the management of Upakusha- GAMC Bangalore 1999
3.Dr. Latha Sahadevan- A study on Upakusha and its management with special reference to Jatipatradi kwatha-GAC Thiruvananthapuram 1995
6.3 OBJECTIVES OF STUDY
1. To evaluate the efficacy of Lekhana karma followed by Lakshadi choorna pratisarana, Yastimadhu grhita kavala and nasya in the management of Upakusha.
2. To evaluate the efficacy of Jatipatradi choorna pratisarana and dantadhawana followed by kavala in the management of Upakusha.
3. To compare the efficacy of Lekhana karma followed by Lakshadi choorna pratisarana, Yastimadhu grhita kavala and nasya with Jatipatradi choorna pratisarana, dantadhavana and kavala in the management of Upakusha.
7. METHODOLOGY
7.1. SOURCE OF DATA
The patients with classical features of Upakusha will be selected from the OPD and IPD , Dept.of Shalakya Tantra, Sri Jayachamarajendra Institute of the Indian Medicine, Bengaluru.
7.2 METHODS OF COLLECTION OF DATA
The cases having classical features of Upakusha which can be correlated with chronic periodontitis will be selected for the study.
INCLUSION CRITERIA
Patients with features of Upakusha namely bright red gingival, inflammation of gingiva, gum recession, halitosis, periodontal pockets, tooth mobility, spontaneous bleeding or bleeding on provocation and deposition of plaque irrespective of sex, age and religion.
EXCLUSION CRITERIA
Other types of Peridontitis except Chronic periodontitis .
Periodontitis having hyperplasia or Neoplasia.
Haemorrhagic disorders.
Any other systemic disorders.
STUDY DESIGN
Total 40 patients will be selected for the study. They will be divided into 2 groups
A & B where each group consists of 20 patients.
Group A - will be treated by Lekhana karma on 1st day followed by Pratisarana with choornas of laksha, priyangu, patanga, lavanottama, gairika, kushta, shunti, maricha, yastimadhu, rasanjana in equal quantity mixed with ghrita and madhu, then kavala and pratimarsha nasya with yastimadhu ghrita twice daily for a period of 14 days.
Group B - will be treated by Jatipatradi choorna Pratisarana, Dantadhavana and Kavala twice daily for a period of 14 days.
All the kalpas shall be prepared as mentioned in the Classics.
DURATION
Total duration of treatment will be 14 days in each group. Clinical findings and symptoms before, during and after treatment shall be observed and recorded in the proforma of the case sheet.
FOLLOW UP PERIOD
Patients will be reviewed once in 2 weeks after treatment for next 60 days.
ASSESSMENT CRITERIA
Assessment will be done on the basis of clinical observation before, during and after
treatment.
PARAMETERS
Subjective: - 1. Halitosis.
2. Bleeding gums.
3. Tooth mobility.
Objective: - 1. Periodontal index.
2. Plaque index.
3. Tooth mobility.
7.3 INVESTIGATIONS :
Random blood sugar.
Bleeding and Clotting time.
Radiograph.
7.4 ETHICAL CLEARANCE
Has been obtained from ethical committee, Government Ayurvedic Medical College,
Bengaluru for the above said clinical trial.
8. BIBLIOGRAPHY
1. Vagbhata. Ashtanga Hridayam, English translation by Prof K R Srikantamurthy,
3rd ed.Varanasi : Krishnadas academy; 2000. vol 3.pp 586.
2. Carranza Newman.Clinical Periodontology, 11th ed. 2011.pp 825.
3. Shantipriya Reddy. Essentials of Clinical Periodontology and Periodontics.
3rd ed. 2011. pp 492.
9. / SIGNATURE OF THE CANDIDATE10. / REMARKS OF GUIDE
11. / NAME AND DESIGNATION OF THE GUIDE / Dr. SUJA .K. SREEDHAR MS(AYU)
PROFESSOR,
DEPARTMENT OF P.G. STUDIES IN SHALAKYA TANTRA,
G.A.M.C, BENGALURU-560009
11.1 / SIGNATURE OF GUIDE
11.2 / CO-GUIDE IF ANY
11.3 / SIGNATURE OF THE CO-GUIDE
11.4 / NAME AND DESIGNATION OF
HEAD OF THE DEPARTMENT / Dr.B.N.RAMESH MD(AYU)(SHALAKYA)
PROFESSOR AND HOD,
DEPARTMENT OF P.G. STUDIES IN
SHALAKYA TANTRA,
G.A.M.C., BENGALURU-560009
11.5 / SIGNATURE OF H.O.D.
12.1 / REMARKS OF PRINCIPAL
12.2 / SIGNATURE OF PRINCIPAL
10